Papers by josien de klerk
Title Heaviness, intensity, and intimacy: Dutch elder care in the context of
Social Science & Medicine
Touch in the new '1.5-metre society' It is the third week of social distancing and my eight-year ... more Touch in the new '1.5-metre society' It is the third week of social distancing and my eight-year old daughter has already embodied the 1.5 metres distance. When she sees people cycling towards her on the heathland near our house, she automatically moves off the path. Not panicky, likes she does when she meets the wild cows, but habitually. Social distancing has created this strange demarcation. We-our family unit-are the safe ones. But those who were extensions of our safe unit-our parents, siblings, friends-are the dangerous others to whom we are dangerous too. My two-year-old son asks me to facetime his grandma. I watch as he routinely-yes routinely, I am already using that word-takes the phone into his little hands and hobbles with her through the house, showing her his train, as if he were holding her hand. His hand feels rough and dry, like all our hands, from washing all the time. He has become a pro. He tells me 'first water mummy, then soap, then wash'. The habitual of touching-surfaces, food, people, our faces-has altered completely in the space of three weeks. This is the '1.5-metre society', a term coined by the Dutch prime minister in his press conference on 7 April. He added that we will have to live in that society for a long time to come. From the perspective of a researcher working on aging and the relationality of care, mostly in the context of the HIV/AIDS epidemic in Eastern Africa, I am intrigued by the rapid absorption of the social distancing message in everyday routines in the Netherlands. HIV/AIDS has been described as an exceptional disease because it had the power to change the habitual of everyday life (Dilger and Luig 2010); mourning rituals, the ways of having sex, ways of (grand)parenting orphaned children. Social distancing requires an extreme change in the habitual of everyday life. To protect the vulnerable, we need to limit touching care. Amid the mortality figures, stories of trauma start surfacing. In the south of the Netherlands, the first epicentre of the COVID-19 epidemic, a wife said goodbye to her husband through facetime, a nurse holding his hand. A priest gave the sacrament for the sick with a ball of cotton wool, in full protective gear, while family were watching from the garden, desperately trying to be present. A mayor: 'The prime minister urged us to care for each other, but we are not allowed to hold each other'. A man who did hold his dying father's hand but now, in his grief, eats alone at a table a few metres away from his family. Quarantined. The unquestioned habit of touching, nearness in caring for the other, never became clearer than in experiences of dying and mourning alone. And only today, an elderly lady, whom we are supposed to be 'protecting', wished she was dead as her homecare radically decreased. As we are learning to live with COVID-19 in our midst, what is care to become? This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Social Anthropology, May 1, 2020
Touch in the new '1.5-metre society' It is the third week of social distancing and my eight-year ... more Touch in the new '1.5-metre society' It is the third week of social distancing and my eight-year old daughter has already embodied the 1.5 metres distance. When she sees people cycling towards her on the heathland near our house, she automatically moves off the path. Not panicky, likes she does when she meets the wild cows, but habitually. Social distancing has created this strange demarcation. We-our family unit-are the safe ones. But those who were extensions of our safe unit-our parents, siblings, friends-are the dangerous others to whom we are dangerous too. My two-year-old son asks me to facetime his grandma. I watch as he routinely-yes routinely, I am already using that word-takes the phone into his little hands and hobbles with her through the house, showing her his train, as if he were holding her hand. His hand feels rough and dry, like all our hands, from washing all the time. He has become a pro. He tells me 'first water mummy, then soap, then wash'. The habitual of touching-surfaces, food, people, our faces-has altered completely in the space of three weeks. This is the '1.5-metre society', a term coined by the Dutch prime minister in his press conference on 7 April. He added that we will have to live in that society for a long time to come. From the perspective of a researcher working on aging and the relationality of care, mostly in the context of the HIV/AIDS epidemic in Eastern Africa, I am intrigued by the rapid absorption of the social distancing message in everyday routines in the Netherlands. HIV/AIDS has been described as an exceptional disease because it had the power to change the habitual of everyday life (Dilger and Luig 2010); mourning rituals, the ways of having sex, ways of (grand)parenting orphaned children. Social distancing requires an extreme change in the habitual of everyday life. To protect the vulnerable, we need to limit touching care. Amid the mortality figures, stories of trauma start surfacing. In the south of the Netherlands, the first epicentre of the COVID-19 epidemic, a wife said goodbye to her husband through facetime, a nurse holding his hand. A priest gave the sacrament for the sick with a ball of cotton wool, in full protective gear, while family were watching from the garden, desperately trying to be present. A mayor: 'The prime minister urged us to care for each other, but we are not allowed to hold each other'. A man who did hold his dying father's hand but now, in his grief, eats alone at a table a few metres away from his family. Quarantined. The unquestioned habit of touching, nearness in caring for the other, never became clearer than in experiences of dying and mourning alone. And only today, an elderly lady, whom we are supposed to be 'protecting', wished she was dead as her homecare radically decreased. As we are learning to live with COVID-19 in our midst, what is care to become? This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Medical Anthropology, Sep 20, 2016
UvA-DARE (Digital Academic Repository) 'A Body Like a Baby' Social self-care among older people w... more UvA-DARE (Digital Academic Repository) 'A Body Like a Baby' Social self-care among older people with chronic HIV in Mombasa
Culture, Health & Sexuality, Nov 1, 2012
In northwest Tanzania, where AIDS has been present for 25 years, AIDS-related illness is a trigge... more In northwest Tanzania, where AIDS has been present for 25 years, AIDS-related illness is a trigger through which community members discuss personal experiences of loss and assess social relationships. The terminal phase of AIDS demands intimate social relations between patients and caretakers. In this final phase of illness, caretakers are scrutinised for their behaviour towards the patient. In the moral world in which caregiving takes place, the act of concealing is considered an intrinsic part of proper care. Current debates on morality, stigma and secrecy inform my argument that acts of concealment around dying are not so much related to the exclusion and ostracism of patients but to inclusion and compassionate care.
Medicine anthropology theory, Dec 1, 2014
In the Netherlands the recent shift to a 'participation society' has led to a reconfiguration of ... more In the Netherlands the recent shift to a 'participation society' has led to a reconfiguration of health care arrangements for long-term care. The new long-term care act, scheduled to commence January 2015, forms the political realization of the participation society: people are expected to decrease their dependency on state provisions and instead become self-sufficient or dependent on family and community solidarity. In this Think Piece we argue that the implicit references of policy makers to pre-welfare state community solidarity and self-sufficiency do not adequately consider the historical and social embeddedness of care. Referring to Rose's concept of 'politics of conduct' we argue that in framing care as a moral obligation, the current politics of conduct may obscure the physical and psychological heaviness of intimate care between family members, the diversity of care relations, and their sociohistorical embeddedness. The participation project In recent years health care arrangements in the Netherlands have changed rapidly. The combination of rising care costs, an aging population, and the 2008 global economic crisis has led to a series of austerity measures aimed at cost containment and reduction in recent years. These austerity measures go hand in hand with a more ideological project: the gradual shift from a caring state to a 'participation society' 1 based on the claim that the welfare state contributed to a loss of social solidarity and individual responsibility.
Anthropology & Medicine, Aug 30, 2019
Drawing on long-term ethnographic fieldwork on older caregivers and their shifting roles since th... more Drawing on long-term ethnographic fieldwork on older caregivers and their shifting roles since the introduction of antiretroviral therapy in northwest Tanzania, this article explores grandmothers' roles in caring for grandchildren who are HIV positive and on treatment. While AIDS treatment programmes usually focus on cultivating expert patients who can perform self-care, this study focuses on older caregivers and how they become experts in caring for their grandchildren living with HIV. How is expert care enacted and what supports or limits its quality? Based on observations and in-depth interviews, this article argues that grandmothers become 'expert caregivers' by merging knowledge acquired in the clinic and support groups with intimate practices of grandparental care. However, the grandmother's gendered and generational position within kin networks affects her ability to provide expert care. The findings indicate that in analysing treatment outcomes among adolescents, it is important to understand the broader family dynamic that influences the actual possibility of expert caregivers to support children living with HIV. 'Weight' is derived from scales used in institutions such as schools and clinics to convert the 'homework' of self-care (Meinert 2013) into numbers that carry a specific significance: is this person or caregiver adhering to ART? This is the 'measured body' , as Whyte (2014) calls it: the use of an objective metric that subtly conceptualises the body in a specific
... Shaibu, S., Wallhagen, M.(2002) Family caregiving of the elderly in Botswana: Boundaries of c... more ... Shaibu, S., Wallhagen, M.(2002) Family caregiving of the elderly in Botswana: Boundaries of culturally acceptable options and resources. ... Brazilian dancer and choreographer Ismael Ivo, presently also the artistic counselor, and the dancer and choreographer Joe Alegado from ...
§ Treatment trajectories § Combining prayer, herbal treatment and biomedical drugs § Religion and... more § Treatment trajectories § Combining prayer, herbal treatment and biomedical drugs § Religion and general health-seeking behaviour § How biomedical treatment shapes religious practices § ART, the absence of cure, and spiritual therapy § Therapies in conflict § Religion and treatment adherence § Religion, ART and disclosure 5. New Agendas for Development and Research Sources FAITH MATTERS FBOs, the public administrations they interact with, and ART users. Meeting these challenges is critical not only for achieving universal access to ART but also for improving service quality and empowering users. The finding can be summarized as follows: SUMMARY 1. The majority of research projects on which this document draws have been carried out in Christian contexts. As a result, the document is characterized by an overall focus on Christian involvement in ART programmes. 1. AIDS, RELIGION AND ART IN AFRICA 2. The list of papers and studies on which this article draws can be found at the end.
The HIV/AIDS epidemic in northwest Tanzania has profoundly shaped the experience of growing old. ... more The HIV/AIDS epidemic in northwest Tanzania has profoundly shaped the experience of growing old. Older men and women take on new care tasks, such as caring for orphaned grandchildren and nursing dying patients. Yet, at the same time, while the elderly grow older, their own old-age care becomes increasingly uncertain. Situating older people's stories in debates around kinship and relating, this detailed ethnographic account captures the diverse experiences of growing old in the era of AIDS and shows how this process implies a tension between the increased necessity to forge relations of care and the confrontation with the aging body. Josien de Klerk obtained her masters degree in medical anthropology at the Radboud University, Nijmegen. She is currently working as a post-doctoral researcher at the University of Amsterdam.
Ageing in Sub-Saharan Africa
PLOS ONE, 2022
Background Differentiated service delivery (DSD) offers benefits to people living with HIV (impro... more Background Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery). ART clubs, 15–30 clients who usually meet within the community, are one of the most common DSD options. However, evidence about the quality of care (QoC) delivered in ART clubs is still limited. Materials and methods We conducted a concurrent triangulation mixed-methods study as part of the Test & Treat project in northwest Tanzania. We surveyed QoC among stable clients and health care workers (HCW) comparing between clinics and clubs. Using a Donabedian framework we structured the analysis into three levels of assessment: structure (staff, equipment, supplies, venue), processes (time-spent, screenings, information, HCW-attitude), and outcomes (viral load, CD4 count, retention, self-worth). Results We surveyed 629 clients (40% in club) and conducted eight focus group discussions, while 24 ...
Anthropology & Medicine, 2019
Drawing on long-term ethnographic fieldwork on older caregivers and their shifting roles since th... more Drawing on long-term ethnographic fieldwork on older caregivers and their shifting roles since the introduction of antiretroviral therapy in northwest Tanzania, this article explores grandmothers' roles in caring for grandchildren who are HIV positive and on treatment. While AIDS treatment programmes usually focus on cultivating expert patients who can perform self-care, this study focuses on older caregivers and how they become experts in caring for their grandchildren living with HIV. How is expert care enacted and what supports or limits its quality? Based on observations and in-depth interviews, this article argues that grandmothers become 'expert caregivers' by merging knowledge acquired in the clinic and support groups with intimate practices of grandparental care. However, the grandmother's gendered and generational position within kin networks affects her ability to provide expert care. The findings indicate that in analysing treatment outcomes among adolescents, it is important to understand the broader family dynamic that influences the actual possibility of expert caregivers to support children living with HIV. 'Weight' is derived from scales used in institutions such as schools and clinics to convert the 'homework' of self-care (Meinert 2013) into numbers that carry a specific significance: is this person or caregiver adhering to ART? This is the 'measured body' , as Whyte (2014) calls it: the use of an objective metric that subtly conceptualises the body in a specific
Medicine Anthropology Theory | An open-access journal in the anthropology of health, illness, and medicine, 2014
In the Netherlands the recent shift to a 'participation society' has led to a reconfiguration of ... more In the Netherlands the recent shift to a 'participation society' has led to a reconfiguration of health care arrangements for long-term care. The new long-term care act, scheduled to commence January 2015, forms the political realization of the participation society: people are expected to decrease their dependency on state provisions and instead become self-sufficient or dependent on family and community solidarity. In this Think Piece we argue that the implicit references of policy makers to pre-welfare state community solidarity and self-sufficiency do not adequately consider the historical and social embeddedness of care. Referring to Rose's concept of 'politics of conduct' we argue that in framing care as a moral obligation, the current politics of conduct may obscure the physical and psychological heaviness of intimate care between family members, the diversity of care relations, and their sociohistorical embeddedness. The participation project In recent years health care arrangements in the Netherlands have changed rapidly. The combination of rising care costs, an aging population, and the 2008 global economic crisis has led to a series of austerity measures aimed at cost containment and reduction in recent years. These austerity measures go hand in hand with a more ideological project: the gradual shift from a caring state to a 'participation society' 1 based on the claim that the welfare state contributed to a loss of social solidarity and individual responsibility.
Medical Anthropology, 2016
UvA-DARE (Digital Academic Repository) 'A Body Like a Baby' Social self-care among older people w... more UvA-DARE (Digital Academic Repository) 'A Body Like a Baby' Social self-care among older people with chronic HIV in Mombasa
Culture, Health & Sexuality, 2012
In northwest Tanzania, where AIDS has been present for 25 years, AIDS-related illness is a trigge... more In northwest Tanzania, where AIDS has been present for 25 years, AIDS-related illness is a trigger through which community members discuss personal experiences of loss and assess social relationships. The terminal phase of AIDS demands intimate social relations between patients and caretakers. In this final phase of illness, caretakers are scrutinised for their behaviour towards the patient. In the moral world in which caregiving takes place, the act of concealing is considered an intrinsic part of proper care. Current debates on morality, stigma and secrecy inform my argument that acts of concealment around dying are not so much related to the exclusion and ostracism of patients but to inclusion and compassionate care.
PLOS ONE, 2021
Objective This study examined people’s motivations for (repeatedly) utilizing HIV testing service... more Objective This study examined people’s motivations for (repeatedly) utilizing HIV testing services during community-based testing events in urban and rural Shinyanga, Tanzania and potential implications for Universal Health Coverage (UHC). Methods As part of a broader multidisciplinary study on the implementation of a HIV Test and Treat model in Shinyanga Region, Tanzania, this ethnographic study focused on community-based testing campaigns organised by the implementing partner. Between April 2018 and December 2019, we conducted structured observations (24), short questionnaires (42) and in-depth interviews with HIV-positive (23) and HIV-negative clients (8). Observations focused on motivations for (re-)testing, and the counselling and testing process. Thematic analysis based on inductive and deductive coding was completed using NVivo software. Results Regular HIV testing was encouraged by counsellors. Most participants in testing campaigns were HIV-negative; 51.1% had tested more t...
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Papers by josien de klerk