Papers by Lenore Manderson
BMC Public Health
Background In seeking the attainment of Universal Health Coverage (UHC), there has been a renewed... more Background In seeking the attainment of Universal Health Coverage (UHC), there has been a renewed emphasis on the role of communities. This article focuses on social innovation and whether this concept holds promise to enhance equity in health services to achieve UHC and serve as a process to enhance community engagement, participation, and agency. Methods A cross-country case study methodology was adopted to analyze three social innovations in health in three low- and middle-income countries (LMICs): Philippines, Malawi, and Colombia. Qualitative methods were used in data collection, and a cross-case analysis was conducted with the aid of a simplified version of the conceptual framework on social innovation as proposed by Cajaiba-Santana. This framework proposes four dimensions of social innovation as a process at different levels of action: the actors responsible for the idea, the new idea, the role of the institutional environment, and the resultant changes in the health and soci...
Discourses of Trust, 2013
Trust informs choices and actions; as a theme, it recurs implicitly and sometimes explicitly thro... more Trust informs choices and actions; as a theme, it recurs implicitly and sometimes explicitly throughout discourses of health and illness. In this chapter, we explore the discursive construction of trust that emerged in narratives of care provision and receipt from allied health professionals and their clients, who through chronic disease, infection or accident had experienced lower limb amputation. Like all narratives, these illustrate how people make sense of events, and the underpinning ideologies and structures that frame these understandings (Frank 1995; Riessman 1990, 2008). Trust is actively produced through discourses of practice in clinical settings. But trust is also conferred retrospectively, through reflections on the outcome of, and cumulative experiences of, multiple consultations, procedures and interactions. And, as we show, trust is fragile where the outcomes are equivocal. Trust is dynamic, not fixed, and so it is iterative-it develops and changes. But there are also two types of trust. One is implicit, produced institutionally by professional training, registration, institutional accreditation, and so forth (see Gilson 2003; Gilson, Palmer & Schneider 2005; Russell 2005). Simply because a doctor has a clinic and takes patients can be enough of a symbol: if he or she can accept patients, then they are assumed to be qualified, capable and trustworthy. This institutionalised trust contrasts with a second type of trust created, rendered, negotiated and eroded through interactions, decisions and particular outcomes. These two different forms overlap under different medical circumstances, but also, they are influenced by social forces. Socioeconomic status, ethnicity, and other socio-cultural factors shape who trusts, who is seen as trustworthy, and in what contexts (Knudsen 1995; Stoutland 2001; Tyler 2005). Hospitals, General Practice clinics, laboratories, rehabilitation wards, and medical specialists all capture the varying affective, instrumental, altruistic and cognitive aspects of institutionalised and inherent trust (Gilson 2003; Goudge & Gilson 2005). But while medicine and its physical sites are C. N. Candlin and J. Crichton (Eds.), Discourses of Trust © Palgrave Macmillan, a division of Macmillan Publishers Limited 2013 At the boundaries of the clinic 87 generally perceived as trustworthy, there is also a hierarchy of trustworthiness (Gilson 2003; Hardin 2002). Hospitals are arguably the premier example of how trust is materialised. In Australia, tertiary hospitals 1-large structures of concrete, glass and steel, with vast entrance halls, surveillance systems, people in uniforms, and high technology-exude an atmosphere of expertise and competence, urgency, serious intent and professionalism (Giddens 1990; Russell 2005). Hospital employees have little time to build relationships to establish trust over time; clinicians, hospital administrative and other medical staff are assumed to act in the best interests of their patients, including in terms of diagnostic accuracy and successful treatment (Ahern & Hendryx 2003). The 'trust task' is therefore not to build trust but rather, to prevent its loss (Russell 2005). In contrast, regional hospitals are smaller and more modest, with less equipment and fewer specialists. The domesticated ambience of these institutions may be intended to increase patient accessibility, but the symbolism of this reduces the implied authoritative basis. Patients are encouraged to participate in decision-making; by doing so, they challenge the authority of medicine. Trust here is therefore more tenuous than in tertiary hospital settings. Providers must spend time with patients, assuring them of their competence, to prevent the breakdown of trust. In the clinical settings of such smaller hospitals, personal relationships are only partly displaced by shared understandings related to professional roles, knowledge, skills and competency. General practitioner (GP) clinics, primary health clinics and allied health settings, including rehabilitation wards, are less authoritative in structure, and in the constructed distance between patient and provider. In these settings, trust is reaffirmed through narrative emplotment (see Mattingly 1994), as providers describe the next steps awaiting the patient; trust is reinforced as each step is reached. Drawing on the narratives of men and women who have had amputations, we illustrate how everyday interactions within and outside of clinics and rehabilitation wards, and extra-clinic and follow-up enquiries of health concerns, build or break trust.
Understanding the Situation "I can't cope anymore!" "This is too much-I've had it!" Is this what ... more Understanding the Situation "I can't cope anymore!" "This is too much-I've had it!" Is this what you are feeling right now? Comments such as these are common every day occurrences in our busy lives-and we call it STRESS. Although never quite adequately defined, vague generalisations such as "Stress and tension are normal reactions to events that threaten us" are used to describe it. Such threats can come from accidents, financial troubles and problems on the job or with family and through our emotional and physical reactions to the given situations, we become what is termed 'stressed'. Not that long ago, the terms of worry, anxiety, fear, impatience, and anger gave way to what has been formally termed 'stress' and its offshoots, stressful, stress-related, and stressed-out. Further complicating matters is the fact that different people react to the same "stress" in unpredictable ways. Stress is not a diagnosis but a process happening over time. The level and extent of stress a person may feel depends a great deal on their attitude to a particular situation. An event which may be extremely stressful for one person can be a minor event in another person's life. Stress is not always a bad thing because some people thrive on it and even need it to get things done. However, when the term 'stress' is used in a clinical sense, it generally refers to a situation that causes discomfort and distress for a person and that is the area we will look at in this article. Regardless of who you are or what you do, chances are you spend a lot of time entrenched in the busyness of life, worrying about getting everything done, and feeling out of control. We feel obligations and pressures which are both physical and mental and the attached stress, which can be quite debilitating, is not always obvious to us. A recent poll found that 40 percent of people feel stressed every day and another 39 percent are sometimes stressed.
Rural and remote health, 2015
INTRODUCTION Poor maternal health outcome, still a major health problem in developing countries, ... more INTRODUCTION Poor maternal health outcome, still a major health problem in developing countries, is influenced by both women's personal characteristics and the characteristics of the place where they live. Identifying the spatial distribution and clusters of poor maternal health outcomes can assist in developing geographically specific interventions. This article examines the influence of urban and rural settings on antenatal care and birthing decisions in South Sulawesi, a province in Indonesia, and investigates the existence of geographical clusters of women's decision regarding antenatal care and birth assistance. METHODS Data were derived from a survey of 485 women who recently gave birth. Household coordinates, midwives' location and hospital location were recorded using a handheld global positioning system (GPS). Logistic regression was used to examine the influence of place of residence on antenatal care and women's birthing decisions. SaTScan software was use...
innovation anD new technologies to tackle inFectious Diseases oF poverty Chapter 4 global report ... more innovation anD new technologies to tackle inFectious Diseases oF poverty Chapter 4 global report for research on infectious Diseases of poverty 97 innovation anD new technologies to tackle inFectious Diseases oF poverty innovation anD new technologies to tackle inFectious Diseases oF poverty Chapter 4 global report for research on infectious Diseases of poverty 99 innovation anD new technologies to tackle inFectious Diseases oF poverty innovation anD new technologies to tackle inFectious Diseases oF poverty Chapter 4 global report for research on infectious Diseases of poverty 101 innovation anD new technologies to tackle inFectious Diseases oF poverty innovation anD new technologies to tackle inFectious Diseases oF poverty Chapter 4 global report for research on infectious Diseases of poverty 115 innovation anD new technologies to tackle inFectious Diseases oF poverty innovation anD new technologies to tackle inFectious Diseases oF poverty Chapter 4 global report for research on infectious Diseases of poverty 117 innovation anD new technologies to tackle inFectious Diseases oF poverty
cultural assessment questions Maternity services overseas Concomitant conditions and cultural gro... more cultural assessment questions Maternity services overseas Concomitant conditions and cultural groups Female genital mutilation Cultural issues in group education Psychological and social issues relating to pregnancy and early parenthood Cultural profiles: Additional cultural assessment questions and prompts References CULTURAL DIMENSIONS OF PREGNANCY, BIRTH AND POST-NATAL CARE This chapter on the cultural dimensions of pregnancy, birth and post-natal care has been produced for Queensland Health by Victoria Team,
No existing scale has been designed for, and validated in, the Australian context which can objec... more No existing scale has been designed for, and validated in, the Australian context which can objectively evaluate the levels of general racist attitudes in Australian individuals or groups. Existing Australian measures of racist attitudes focus on single groups or have not been validated across the lifespan. Without suitable instruments, racism reduction programs implemented in Australia cannot be appropriately evaluated and so cannot be judged to be making a meaningful difference to the attitudes of the participants. To address the need for a general measure of racial, ethnic, cultural, and religious acceptance, an Australian scale was developed and validated for use with children, adolescents, and adults. The Racism, Acceptance, and Cultural-Ethnocentrism Scale (RACES) is a 34-item self-report instrument measuring explicit racist attitudes, consisting of three interdependent subscales (Accepting Attitudes – 12 items; Racist Attitudes – 8 items; Ethnocentric Attitudes – 4 items) and...
Objective : To explore the adaptation process among Thai-Isan women who had converted from Buddhi... more Objective : To explore the adaptation process among Thai-Isan women who had converted from Buddhism to Islam. Methods : Qualitative approach was conducted during September 2012 to August 2013. Twenty one Thai-Isan women, who converted from Buddhism to Islam and identified themselves as Muallaf, participated in this study. Data were collected via in-depth interviews, natural conversations, observations and field notes, and were analyzed using thematic analysis. Triangulation was used to ensure the quality of the research. Results : All 21 Mualluf faced stressful situations that were risk of emotional crisis but they did not have mental health problems. Converting from Buddhist to Muslim was regarded as changing way of life. An adaptation process of the muallaf was divided into 3 phases including Phase 1: considering religious conversion Phase 2: identity transition and Phase 3: maintaining a new identity. In addition it was found that social support helped the muallaf’s transition sm...
The Devil's Fruit, 2021
Medical Anthropology: Health, In equality, and Social Justice aims to capture the diversity of co... more Medical Anthropology: Health, In equality, and Social Justice aims to capture the diversity of con temporary medical anthropological research and writing. The beauty of ethnography is its capacity, through storytelling, to make sense of suffering as a social experience, and to set it in context. Central to our focus in this series, therefore, is the way in which social structures, po liti cal and economic systems and ideologies shape the likelihood and impact of infections, injuries, bodily ruptures and disease, chronic conditions and disability, treatment and care, social repair, and death. Health and illness are social facts; the circumstances of the maintenance and loss of health are always and everywhere shaped by structural, local, and global relations. Social formations and relations, culture, economy, and po liti cal organization, as much as ecol ogy, shape the variance of illness, disability, and disadvantage. The authors of the monographs in this series are concerned centrally with health and illness, healing practices, and access to care, but in each case they highlight the importance of such differences in context as expressed and experienced at individual, house hold, and wider levels: health risks and outcomes of social structure and house hold economy, health systems factors, and national and global politics and economics all shape people's lives. In their accounts of health, in equality, and social justice, the authors move across social circumstances, health conditions, and geography, and their intersections and interactions, to demonstrate how individuals, communities, and states manage assaults on people's health and well-being. As medical anthropologists have long illustrated, the relationships of social context and health status are complex. In addressing these questions, the authors in this series showcase the theoretical sophistication, methodological rigor, and empirical richness of the field while expanding a map of illness, social interaction, and institutional life to illustrate the effects of material conditions and social meanings in troubling and surprising ways. The books reflect medical anthropology as a constantly changing field of scholarship, drawing on diverse research in residential and virtual communities, clinics and laboratories, emergency care, and public health settings; with ser vice providers, individual healers, and house holds; and with social bodies, human bodies, and biologies. While medical anthropology once concentrated on systems of healing, par tic u lar diseases, and embodied experiences, today the field has expanded to include environmental disaster, war, science, technology, faith, gender-based vio lence, and forced
Medicine Anthropology Theory, 2020
A vast portion of the world’s population live with ill health following acute infection or diseas... more A vast portion of the world’s population live with ill health following acute infection or disease and its emergency management. This reflects the increased capacity of technological innovations and pharmaceuticals to interrupt decline or complications, even when cure is unlikely. The authors in this Special Section illustrate how, in different localities, people live with risk for themselves or their offspring; with non-communicable, degenerative, autoimmune, and congenital conditions; with the after-effects of diagnostic procedures and surgical interventions; and with continued treatment and surveillance. We attend to the value of conceptualising this as ‘living under’ diagnosis or description. We illustrate how diagnostic labels overdetermine subsequent embodied states of being, structuring interactions and social relations with family, friends, and health professionals. Living under diagnosis, we argue, impacts on self-care, care for and by others, everyday lives, and anticipati...
South African Medical Journal, 2018
This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
Malaria Journal, 2018
Background: Behaviour changes in mosquitoes from indoor to outdoor biting result in continuing ri... more Background: Behaviour changes in mosquitoes from indoor to outdoor biting result in continuing risk of malaria from outdoor activities, including routine household activities and occasional social and cultural practices and gatherings. This study aimed to identify the range of social and cultural gatherings conducted outdoors and their associated risks for mosquito bites. Methods: A cross-sectional study was conducted in four villages in the Kilombero Valley from November 2015 to March 2016. Observations, focus group discussions, and key informant interviews were conducted. The recorded data were transcribed and translated from Swahili to English. Thematic content analysis was used to identify perspectives on the importance of various social and cultural gatherings that incidentally expose people to mosquito bites and malaria infection. Results: Religious, cultural and social gatherings involving the wider community are conducted outdoors at night till dawn. Celebrations include life course events, religious and cultural ceremonies, such as Holy Communion, weddings, gatherings at Easter and Christmas, male circumcision, and rituals conducted to please the gods and to remember the dead. These celebrations, at which there is minimal use of interventions to prevent bites, contribute to individual satisfaction and social capital, helping to maintain a cohesive society. Bed net use while sleeping outdoors during mourning is unacceptable, and there is minimal use of other interventions, such as topical repellents. Long sleeve clothes are used for protection from mosquito bites but provide less protection. Conclusion: Gatherings and celebrations expose people to mosquito bites. Approaches to prevent risks of mosquito bites and disease management need to take into account social, cultural and environmental factors. Area specific interventions may be expensive, yet may be the best approach to reduce risk of infection as endemic countries work towards elimination. Focusing on single interventions will not yield the best outcomes for malaria prevention as social contexts and vector behaviour vary.
Gender' and 'sexuality' are elusive terms, commonly used as if self-evident yet as problematic in... more Gender' and 'sexuality' are elusive terms, commonly used as if self-evident yet as problematic in their definitions as in their politics. The simplest distinctions are between sex and gender, in order to differentiate biology and social and behavioral traits, but these distinctions are not made and do not make sense in all cultures (Rubin 1975); anthropologists studying sexuality, as well as queer theorists and activists, have made the insensitivity of this demarcation clear (Jackson 2011). 'Gender' references broader configurations of social life, encompassing ideologies and practices of kinship; sex, in contrast, is generally seen to be a biological classification of living things as male or female according to their external and internal genitalia, their chromosomes, endocrine systems and reproductive organs (Karkazis 2008; Wizemann and Pardue 2001). But as controversies illustrate, such as that over the gold medal for the 800-meter race of the South African woman, Caster Semenya, definitions of male and female are not straightforward. Semenya was found to have an intersex condition, leaving her with no uterus or ovaries and high levels of androgens. Defining one's sex is complex-there is not one biological marker that allows for a simple categorization of people as male or female. Moreover, gendered life experiences impact endocrinological processes, and thereby affect biologically defined sex differences between men and women (Karkazis 2008). Together sex/gender as an intertwined concept contributes to the meanings given to sexuality, and to how it is understood in social, political, and cultural life. 'Sexuality' can refer to sexual feelings, sexual desire, and pleasure; to identity and its implications; and to social arenas where moral discourses on 'good' sexual behavior are played out. In this chapter, we use the term 'sexuality' as a relational concept within a medical anthropological framework, and reflect on the ways that different strands of sexuality research, involving historians, sexologists, and queer and feminist scholars, have contributed to our understanding of these issues. We focus on how sexuality is affected by and how it shapes medical technologies. We approach sexual behavior not as a biologically determined drive, but as a socially and culturally constructed practice shaped by power relations (see, for example, Spronk 2009). Using four case studies, we show how sexuality has been shaped by access to medical technology, and how medical technologies can be experienced and analyzed as liberating and oppressive, reflecting and shaping cultural notions of appropriate sexual identities, practices, and gender roles. Note 1. Kathoei refers to sexually diverse people. See Jackson (2010) and Käng (2012).
Journal of Aging and Health, 2019
Objectives: The objective of this study is to analyze the degree to which care needs are met in a... more Objectives: The objective of this study is to analyze the degree to which care needs are met in an aging rural African population. Method: Using data from the Health and Aging in Africa: Longitudinal Study of an INDEPTH Community (HAALSI) baseline survey, which interviewed 5,059 adults aged older than 40 years in rural South Africa, we assessed the levels of limitations in activities of daily living (ADLs) and in unmet care for these ADLs, and evaluated their association with sociodemographic and health characteristics. Results: ADL impairment was reported by 12.2% of respondents, with the proportion increasing with age. Among those with ADL impairment, 23.9% reported an unmet need and 51.4% more a partially met need. Relatives provided help most often; formal care provision was rare. Unmet needs were more frequent among younger people and women, and were associated with physical and cognitive deficits, but not income or household size. Discussion: Unmet care needs in rural South Af...
American Anthropologist, 2018
F or this special guest-edited section of World Anthropologies, we wanted to bring together essay... more F or this special guest-edited section of World Anthropologies, we wanted to bring together essays that described, critiqued, or analyzed what is often called medical anthropology from various places and perspectives in the world. Our call for papers, which we included in several international listservs and newsletters, and which we emailed to a handful of people who were recommended to us, left open the possibility to very broadly construe "medical anthropology." We wrote that we sought short essays "on anthropological approaches to recovery, treatment, cure, healing, rehabilitation, and living with chronic or acute illness, injury, or condition." Our interest in compiling this special section was twofold. First, we sought to illuminate the multiplicity of medical anthropology as it is practiced outside of the United States. Indeed, one of the featured essays proposes that "health anthropology" is a more apt term than "medical anthropology" for what Debbi Long, Hans Baer, and their colleagues are doing in Australia. Second, we invited our contributors to identify some of the challenges (as well as advantages) faced by medical anthropologists who may work in settings where the discipline is neither recognized nor valued. Several of the essays emphasize a lack of formal specialized training in medical anthropology, particularly prior to graduate school, and this underlies some of the barriers faced by our contributors. Chidi Ugwu makes these barriers explicit in his essay: although the promise of anthropology in dealing with the complexities of postcolonial Nigeria has been (somewhat) identified, there is limited support at the state, academic institutional, or NGO levels through the provision of funding, training, or mentorship. Together, restricted support for and limited recognition of the value of medical anthropology give rise to challenges in translating medical anthropological findings into meaningful outcomes for the populations with whom we work.
Food and Nutrition Bulletin, 1992
Focus groups are an instrument designed to gather information primarily about beliefs, values, an... more Focus groups are an instrument designed to gather information primarily about beliefs, values, and understanding. The participants are specifically selected to explore the range of these beliefs in a study population. Croup dynamics facilitate the collection of relatively detailed information on prevalent attitudes and ideas, conflicts and contradictions. Focus groups are guided by relatively strict rules of structure and procedure. This paper examines the need for flexibility in the conduct of these groups in developing-country settings and argues for their applicability in research on tropical diseases.
Global Health Action, 2017
Background: Pregnancy is life changing, making great demands on women to adapt physically, psycho... more Background: Pregnancy is life changing, making great demands on women to adapt physically, psychologically, and socially. Social relationships and the support that flow from these provide a critical role in managing health problems in pregnancy. Isolation and lack of care, in contrast, may lead women to experience increased distress during this time. Objective: This study aimed to explore South African women's perception and experience of care and support in pregnancy. Methods: A life history approach was employed to explore women's experiences of pregnancy and sexual behaviour, with each participant encouraged to narrate important life events from her own perspective. We drew on narrative interviews with 15 pregnant women, conducted between July and October 2015, in which we explored questions regarding pregnancy planning and the provision and receipt of care. A thematic approach was employed to code and analyse the data. Results: Themes that emerged from the interviews showed that participants gained a sense of stability in their lives when they had support in their pregnancy, especially when dealing with challenging situations. This support came variously from family, friends, and social networks. Overall, those participants who mentioned the most support, and its diversity across different groups, reported a better experience of pregnancy. Conclusions: Women emphasised the importance of social and emotional support in pregnancy. Understanding women's experiences can assist in making pregnancy less overwhelming, and can add to a woman's ability to deal with different challenges before and after the arrival of the new baby.
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Papers by Lenore Manderson