The aim of this special edition of International Migration is to bring about discussion between t... more The aim of this special edition of International Migration is to bring about discussion between those conducting research in Diaspora Studies and the Anthropology of Public Health and Medicine. Historically, international migration has been associated with the transport of disease. Regardless of the evidence, metaphors of plague, and infection have circulated and been used to marginalise and keep out diaspora communities in host countries in an effort to 'exclude filth'. Migrants have been referred to in terms such as the 'Asiatic menace' indicating a virus-like threat to local populations. We look at the impact the traces of these images have on current host nations' perceptions of diaspora communities and also ask what impact does this have on the diasporic communities' self-perceptions, if any? Does this affect conceptions of belonging, or feed into continuing dialogues of displacement? The movement of people has long been associated with the spread of disease and infections. In light of this, we are concerned with the role of medical knowledge and practices in relation to diaspora communities, and how these discourses have contributed to the perception of diaspora populations by host societies, and helped shape wider questions of belonging and citizenship. We aim to look at these questions in their historical context, both in their continuities and discontinuities, emphasising the importance of this to an understanding of current practices. Circuits of migration, and connected medical practices are taking new forms, where, on the one hand migrants are still associated with disease and pollution, but on the other migrants are also increasingly staffing the infrastructure of western public health services. At the same time, the west can no longer lay claim to 'superior' biomedical provision. These shifts signal new
Unlike other countries in South Asia, in Nepal research in the health sector has a relatively rec... more Unlike other countries in South Asia, in Nepal research in the health sector has a relatively recent history. Most health research activities in the country are sponsored by international collaborative assemblages of aid agencies and universities. Data from Nepal Health Research Council shows that, officially, 1,212 health research activities have been carried out between 1991 and 2014. These range from addressing immediate health problems at the country level through operational research, to evaluations and programmatic interventions that are aimed at generating evidence, to more systematic research activities that inform global scientific and policy debates. Established in 1991, the Ethical Review Board of the Nepal Health Research Council (NHRC) is the central body that has the formal regulating authority of all the health research activities in country, granted through an act of parliament. Based on research conducted between 2010 and 2013, and a workshop on research ethics that the authors conducted in July 2012 in Nepal as a part of the on-going research, this article highlights the emerging regulatory and ethical fields in this low-income country that has witnessed these increased health research activities. Issues arising reflect this particular political economy of research (what constitutes health research, where resources come from, who defines the research agenda, culture of contract research, costs of review, developing Nepal's research capacity, through to the politics of publication of data/findings) and includes questions to emerging regulatory and ethical frameworks.
Background: Building appropriate levels of trust in pharmaceuticals is a painstaking and challeng... more Background: Building appropriate levels of trust in pharmaceuticals is a painstaking and challenging task, involving participants from different spheres of life, including producers, distributors, retailers, prescribers, patients and the mass media. Increasingly, however, trust is not just a national matter, but involves cross-border flows of knowledge, threats and promises.
Background: Local pharmaceutical production has been endorsed by the WHO as a means of addressing... more Background: Local pharmaceutical production has been endorsed by the WHO as a means of addressing health priorities of developing countries. However, local producers of essential medicines must comply with international pharmaceutical standards in order to be eligible to compete in donor tenders. These standards determine production rights for on-patent and off-patent medicines, and guide international procurement of medicines. We reviewed the literature on the impact of Good Manufacturing Practice (GMP) on local production; a gap analysis from the literature review indicated a need for further research. Over sixty interviews were conducted with people involved in the Nepali pharmaceutical production and distribution chain from 2006 to 2009 on the GMP areas of relevance: regulatory capacity, staffing, funding and training, resourcing of GMP, inspectors' interpretation of the rules and compliance. Results: Although Nepal producers have increased their overall share of the domestic market, only the public manufacturer, Royal Drugs, focuses on medicines for public health programmes; private producers engage mainly in brand competition for private markets, not essential medicines. Nepali regulators and producers state that implementation of GMP standards is hindered by low regulatory capacity, insufficient training of staff in the industry, financial constraints and lack of investment for upgrading capital. The transition period to mandatory compliance with WHO GMP rules is lengthy. Less than half of private producers had WHO GMP in 2013. Producers are not directly affected by international harmonisation of standards as they do not export medicines and the Nepali regulator does not enforce the WHO standards strictly. Without an international GMP certificate they cannot tender for donor dependent health programmes. Conclusions: In Nepal, local private manufacturers focus mainly on brand competition for private consumption not essential medicines, the government preferentially procures essential medicines from the only public producer while donor funded programmes rely on international manufacturers compliant with international GMP standards. We also found evidence of private hospitals bypassing national medicines approvals process. Policies in support of local pharmaceutical production in developing countries as a source of essential medicines need to examine carefully how GMP regulations impact on regulators, local industry and production of essential medicines in practice.
Is there a relationship between what gets taught in the anthropology classroom and its effects be... more Is there a relationship between what gets taught in the anthropology classroom and its effects beyond that classroom? This paper is structured as a conversation1 about disciplinary 'canons', their role in socialising new teachers and their influence within, between and beyond particular national academies. The transnational circulation of scholarship is of key concern to a discipline that depends on its
Conducting fieldwork in conflict situations raises specific methodological and ethical questions.... more Conducting fieldwork in conflict situations raises specific methodological and ethical questions. While Taussig (1984Taussig ( , 1987Taussig ( , 1992 and Scheper-Hughes (1995) have called for anthropologists to speak out against terror, they have not addressed in detail how researchers working in war zones should negotiate the pragmatics of representation in dangerous field situations. As Kovats-Bernat (2002) notes, although there is a growing literature that aims to develop theoretical approaches to the study of violence, relatively little attention has been given to the practical concerns surrounding fieldwork in conflict situations.1 What is needed, he argues, is 'the adoption of new tactics for ethnographic research and survival in dangerous field sites -strategies that challenge the conventional ethics of the discipline, reconfigure the relationships between anthropologist and informant, and compel innovation in negotiating the exchange of data under hazardous circumstances ' (2002: 208). Danny Hoffman (2003 similarly addresses this issue with his call for a reconsideration of 'frontline anthropology' techniques. We contribute to this discussion by examining these questions within the rapidly changing context of Nepal, where a bitter internal conflict has developed over the last eight years.
Anthropologists and psychiatrists traditionally have used the salience of a mind-body dichotomy t... more Anthropologists and psychiatrists traditionally have used the salience of a mind-body dichotomy to distinguish Western from non-Western ethnopsychologies. However, despite claims of mind-body holism in non-Western cultures, mindbody divisions are prominent in non-Western groups. In this article, we discuss three issues: the ethnopsychology of mind-body dichotomies in Nepal, the relationship between mind-body dichotomies and the hierarchy of resort in a medical pluralistic context, and, finally, the role of mind-body dichotomies in public health interventions (biomedical and psychosocial) aimed toward decreasing the stigmatization of mental illness. We assert that, by understanding mind-body relations in non-Western settings, their implications, and ways in which to reconstitute these relations in a less stigmatizing manner, medical anthropologists and mental health workers can contribute to the reduction of stigma in global mental health care.
The aim of this special edition of International Migration is to bring about discussion between t... more The aim of this special edition of International Migration is to bring about discussion between those conducting research in Diaspora Studies and the Anthropology of Public Health and Medicine. Historically, international migration has been associated with the transport of disease. Regardless of the evidence, metaphors of plague, and infection have circulated and been used to marginalise and keep out diaspora communities in host countries in an effort to 'exclude filth'. Migrants have been referred to in terms such as the 'Asiatic menace' indicating a virus-like threat to local populations. We look at the impact the traces of these images have on current host nations' perceptions of diaspora communities and also ask what impact does this have on the diasporic communities' self-perceptions, if any? Does this affect conceptions of belonging, or feed into continuing dialogues of displacement? The movement of people has long been associated with the spread of disease and infections. In light of this, we are concerned with the role of medical knowledge and practices in relation to diaspora communities, and how these discourses have contributed to the perception of diaspora populations by host societies, and helped shape wider questions of belonging and citizenship. We aim to look at these questions in their historical context, both in their continuities and discontinuities, emphasising the importance of this to an understanding of current practices. Circuits of migration, and connected medical practices are taking new forms, where, on the one hand migrants are still associated with disease and pollution, but on the other migrants are also increasingly staffing the infrastructure of western public health services. At the same time, the west can no longer lay claim to 'superior' biomedical provision. These shifts signal new
Unlike other countries in South Asia, in Nepal research in the health sector has a relatively rec... more Unlike other countries in South Asia, in Nepal research in the health sector has a relatively recent history. Most health research activities in the country are sponsored by international collaborative assemblages of aid agencies and universities. Data from Nepal Health Research Council shows that, officially, 1,212 health research activities have been carried out between 1991 and 2014. These range from addressing immediate health problems at the country level through operational research, to evaluations and programmatic interventions that are aimed at generating evidence, to more systematic research activities that inform global scientific and policy debates. Established in 1991, the Ethical Review Board of the Nepal Health Research Council (NHRC) is the central body that has the formal regulating authority of all the health research activities in country, granted through an act of parliament. Based on research conducted between 2010 and 2013, and a workshop on research ethics that the authors conducted in July 2012 in Nepal as a part of the on-going research, this article highlights the emerging regulatory and ethical fields in this low-income country that has witnessed these increased health research activities. Issues arising reflect this particular political economy of research (what constitutes health research, where resources come from, who defines the research agenda, culture of contract research, costs of review, developing Nepal's research capacity, through to the politics of publication of data/findings) and includes questions to emerging regulatory and ethical frameworks.
Background: Building appropriate levels of trust in pharmaceuticals is a painstaking and challeng... more Background: Building appropriate levels of trust in pharmaceuticals is a painstaking and challenging task, involving participants from different spheres of life, including producers, distributors, retailers, prescribers, patients and the mass media. Increasingly, however, trust is not just a national matter, but involves cross-border flows of knowledge, threats and promises.
Background: Local pharmaceutical production has been endorsed by the WHO as a means of addressing... more Background: Local pharmaceutical production has been endorsed by the WHO as a means of addressing health priorities of developing countries. However, local producers of essential medicines must comply with international pharmaceutical standards in order to be eligible to compete in donor tenders. These standards determine production rights for on-patent and off-patent medicines, and guide international procurement of medicines. We reviewed the literature on the impact of Good Manufacturing Practice (GMP) on local production; a gap analysis from the literature review indicated a need for further research. Over sixty interviews were conducted with people involved in the Nepali pharmaceutical production and distribution chain from 2006 to 2009 on the GMP areas of relevance: regulatory capacity, staffing, funding and training, resourcing of GMP, inspectors' interpretation of the rules and compliance. Results: Although Nepal producers have increased their overall share of the domestic market, only the public manufacturer, Royal Drugs, focuses on medicines for public health programmes; private producers engage mainly in brand competition for private markets, not essential medicines. Nepali regulators and producers state that implementation of GMP standards is hindered by low regulatory capacity, insufficient training of staff in the industry, financial constraints and lack of investment for upgrading capital. The transition period to mandatory compliance with WHO GMP rules is lengthy. Less than half of private producers had WHO GMP in 2013. Producers are not directly affected by international harmonisation of standards as they do not export medicines and the Nepali regulator does not enforce the WHO standards strictly. Without an international GMP certificate they cannot tender for donor dependent health programmes. Conclusions: In Nepal, local private manufacturers focus mainly on brand competition for private consumption not essential medicines, the government preferentially procures essential medicines from the only public producer while donor funded programmes rely on international manufacturers compliant with international GMP standards. We also found evidence of private hospitals bypassing national medicines approvals process. Policies in support of local pharmaceutical production in developing countries as a source of essential medicines need to examine carefully how GMP regulations impact on regulators, local industry and production of essential medicines in practice.
Is there a relationship between what gets taught in the anthropology classroom and its effects be... more Is there a relationship between what gets taught in the anthropology classroom and its effects beyond that classroom? This paper is structured as a conversation1 about disciplinary 'canons', their role in socialising new teachers and their influence within, between and beyond particular national academies. The transnational circulation of scholarship is of key concern to a discipline that depends on its
Conducting fieldwork in conflict situations raises specific methodological and ethical questions.... more Conducting fieldwork in conflict situations raises specific methodological and ethical questions. While Taussig (1984Taussig ( , 1987Taussig ( , 1992 and Scheper-Hughes (1995) have called for anthropologists to speak out against terror, they have not addressed in detail how researchers working in war zones should negotiate the pragmatics of representation in dangerous field situations. As Kovats-Bernat (2002) notes, although there is a growing literature that aims to develop theoretical approaches to the study of violence, relatively little attention has been given to the practical concerns surrounding fieldwork in conflict situations.1 What is needed, he argues, is 'the adoption of new tactics for ethnographic research and survival in dangerous field sites -strategies that challenge the conventional ethics of the discipline, reconfigure the relationships between anthropologist and informant, and compel innovation in negotiating the exchange of data under hazardous circumstances ' (2002: 208). Danny Hoffman (2003 similarly addresses this issue with his call for a reconsideration of 'frontline anthropology' techniques. We contribute to this discussion by examining these questions within the rapidly changing context of Nepal, where a bitter internal conflict has developed over the last eight years.
Anthropologists and psychiatrists traditionally have used the salience of a mind-body dichotomy t... more Anthropologists and psychiatrists traditionally have used the salience of a mind-body dichotomy to distinguish Western from non-Western ethnopsychologies. However, despite claims of mind-body holism in non-Western cultures, mindbody divisions are prominent in non-Western groups. In this article, we discuss three issues: the ethnopsychology of mind-body dichotomies in Nepal, the relationship between mind-body dichotomies and the hierarchy of resort in a medical pluralistic context, and, finally, the role of mind-body dichotomies in public health interventions (biomedical and psychosocial) aimed toward decreasing the stigmatization of mental illness. We assert that, by understanding mind-body relations in non-Western settings, their implications, and ways in which to reconstitute these relations in a less stigmatizing manner, medical anthropologists and mental health workers can contribute to the reduction of stigma in global mental health care.
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