This dissertation explores the lasting effects of recurrent temporary medical humanitarian operations through ethnographic research in communities, clinical facilities, nongovernmental aid organizations, and governmental bureaucracies in the northern Somali Region of Ethiopia. First, I found that medical humanitarian aid has altered persons' subjective experiences and expectations of biomedicine, spirit possession, health, and healing. Popular health cultures and conceptions of "biomedicine" as well as "traditional medicine" were changing, in part due to repeated exposures to relief operations. Second, I documented novel social formations to cope with recurrent aid: new labor relations to enable temporary work with international NGOs; new medical migrations to access comparable care and foreign medical commodities at distant private hospitals; and transnational extra-legal economies of medicine to fill gaps in care. Third, a set of racialized narratives have emerged in the interstices of aid that warn of malpractice and abuse by non-Somali Ethiopian clinicians. Such discourses echo Somalis' historical experiences of ethnic-based conflict with Ethiopian groups as well as their contemporary marginalization from Ethiopian sources of power. Accordingly, although aid is designed to improve immediate access to basic healthcare and medications, I find it also exacerbated medical insecurity. Northern Somalis' discursive expressions of medical insecurity have increased, paradoxically alongside steady improvements in their health and nutrition indicators. Finally, health and humanitarian interventions have altered local notions and practices of citizenship. In the last ten years, as Ethiopia has decentralized its health care delivery system, aid has been progressively channeled through Somali Regional State institutions. Accordingly, many Somalis now discuss the diverse ways in which they are increasingly interpolated into regional politics-often in opposition to the Ethiopian government. Medical humanitarian aid has shaped expectations of government as well as biomedicine. I argue that these new forms of citizenship have emerged primarily because of the intimate and profound nature of medical encounters themselves. The narrow humanitarian mission to minister to what social theorists call the "bare life" of victims, in actuality, is neither dispassionate nor removed from sociality and politics. Medical aid potentially provides spaces in which relations of care-giving, trust, and therefore responsive governance structures can develop.

This thesis explores Turkish migrants’ practices of diabetes care in Germany. Health statistics frequently identify minority groups as vulnerable to chronic illness and Turkish-origin Germans are said to be more likely to suffer from type 2 diabetes than Germans or Turks in Turkey. Anthropological studies on marginal population groups with diabetes explore experiences of social suffering and inequality that influence such high illness prevalence, or investigate how conflictual lay beliefs and medical encounters affect illness care. Those studies that analyse active diabetes patient and healthcare practices concentrate on the majority population. Drawing on ethnographic fieldwork in Berlin from September 2006 to September 2007, this thesis examines how Turkish Berliners actively engage in diabetes care, and thus joins two themes seldom connected: illness practices and marginality. Initial interviews with healthcare professionals alluded to a Turkish migrant patient group living in deprivation and immobilised by high illiteracy rates, lacking language skills and health knowledge. Despite such experience of marginality, ethnographic exploration revealed that informal diabetes care, for example through a Turkishlanguage self-help group, is nonetheless individually and collectively negotiated where formal care is inadequate. On the one hand, the thesis investigates practices of diabetes control in learning, monitoring and manoeuvring diabetes. Rather than representing the common image of the inert, disadvantaged migrant patient, Turkish Berliners of the self-help group engage in deliberate “tactics of diabetes control” to make their chronic illness experience habitable. On the other hand, the thesis explores how “diabetes among Turkish-origin Berliners” can be a form of sociality, political activism and economic enterprise that involves many social actors not only patients and their healthcare professionals, in order to fill a provision gap.

Allergies have taken on cultural meanings other than those offered by biomedicine. Interviews with allergic and non-allergic Americans were used to investigate the explanatory models of the lay population. This thesis uses ethnographic data to examine explanatory models of allergic conditions, highlighting metaphorical uses of allergies in American culture. The explanatory models of the subjects were contrasted to the biomedical model and the stereotypes created by the media in the United States. Important topics addressed in the analysis of the interview material were: what are the explanatory models of allergies in America, how do allergies influence the selfimage of someone with that condition, and how Americans with and without allergies perceive the allergic individual. / by Micheline M. Hilpert. / Thesis (M.A.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

This thesis explores the dynamics of healing and care in a terreiro (house of worship) of the Afro-Brazilian religion Candomblé. My research is based on one year of ethnographic fieldwork with a Candomblé community in South Bahia, Brazil, during which I took part in the rituals, ceremonies, and everyday activities of the terreiro, and eventually became a ‘daughter of the house’. While the terreiro is at the heart of this study, I also draw upon observations and experience from the local neighbourhood, the nearest city Ilhéus, the state capital Salvador, and the city of Rio de Janeiro, where I started my journey, to complement and contextualize what I encountered inside the terreiro. I argue that cuidado, or care, is key to the cultivation of Candomblé’s vital force axé, and hence to achieving well-being and power in a socially exclusive society that is often perceived as profoundly uncaring. My thesis demonstrates that the circulation of axé and cuidado between humans and gods (orixás) is an essential part of Candomblé healing, understood as a process of reflexive self-transformation. Far from being altruistic or self-denying, then, cuidado effectively becomes a form of self-care. Subverting dichotomous logic, Candomblé cuidado is used to create and negotiate (healing) power through its capacity to simultaneously connect and divide. This thesis explores how boundaries are both transgressed and reinforced by way of cuidado in terms of transformative healing; kinship relations with the orixás; the exchange of human faith (fé) for divine axé; and performances on ‘divine stages’ and ‘profane stages’. Finally, cuidado is also used as a moral-political argument for the recognition of Candomblé in public health campaigns, in the context of an often-dysfunctional public health system. The analysis of dynamics of cuidado and boundary work in a terreiro, under consideration of the broader national context, makes this thesis an original contribution to the literature on Afro-Brazilian religion and healing. My ethnography also adds to the growing literature on the anthropology of care, especially in medical anthropology, and it pushes forward the discussion by explicitly reflecting on the circulation and negotiation of power through care.

Doctor of Philosophy / This thesis studies the relationship between subjective experience and social environment during recovery from alcoholism in Alcoholics Anonymous (AA). As a result of participation in AA meetings, many alcoholics undergo healing transformations involving a sense of acceptance of themselves, others and the world. In early sobriety these experiences often remove an alcoholic’s desire to drink. Outside AA, however, alcoholics frequently experience subjective unravelling – a sense of conflict with themselves, others and the world. For many, this subjective state is associated with actual or potential craving for a drink. Regular participation in AA meetings alleviates these states. This thesis construes the relationship between subjective experience and immediate social environment in terms of ‘experiential stakes of relevance’. This conceptual category can be used to characterise both the structural properties of the social environment and the key attributes of the subjective experience of agents within this environment. Listening to stories at AA meetings results for many alcoholics in a radical change in ‘experiential stakes of relevance’. It is argued that the process of spontaneous re-connection with one’s past experiences during AA meetings is akin to the process of mobilisation of embodied dispositions as theorised by Bourdieu. Transformation in AA takes place in the space of a mere one and a half hours and involves processes of intensification of experience. These are analysed in terms of Bourdieu’s notion of ‘illusio’ and Chion’s notion of ‘rendu’. The healing experiences of acceptance presuppose a social environment free of interpersonal conflict. This thesis argues that the need to structurally eliminate conflict between alcoholics has turned AA into a social field which is sustained by the very healing subjective experiences that it facilitates. In the process, AA has developed structural elements which can best be understood as mechanisms inverting the social logic of competitive fields. The fieldwork entailed a detailed ethnographic study of one particular group of Alcoholics Anonymous in Sydney’s Lower North Shore as well as familiarisation with the more general culture of AA in Sydney. Methods of investigation included participant observations at AA meetings and interviews with a number of sober alcoholics in AA.

The diagnosis and treatment of depressive and anxiety disorders has changed rapidly in the past century. Western medicine has produced diagnostic criteria, pharmaceuticals, and different therapies, increasing public awareness of these conditions. This research investigates the potential and perceived cultural, familial, and political influences on anxiety and depressive disorders in the current biomedical system; analyzes the effects of this system on the patients within it; and compares the causality, diagnosis, and treatment of these conditions cross-culturally. To accomplish these research goals, I conducted in-depth interviews with people affected by depression and anxiety in the Atlanta area. I will present my analysis of the interview data collected, focusing on the extent to which each participants' familial and cultural backgrounds and attitudes towards biomedicine affected their choices and experiences with treatment. I also explore the role of pharmaceutical advertising and marketing strategies in patients’ perceptions of their disorder and treatment options.

This paper contributes to a growing body of literature on women with endometriosis, a gynecological condition in which tissue similar to the endometrium, or lining of the uterus which is shed during menses, grows elsewhere in the body. Despite a growing understanding of the disease in medical literature, it is still not well known by the general population or fully understood by the medical community. The paper incorporates a biomedical understanding with Emma Whelan’s idea of these women as an epistemological community, autoethnography, and narratives of sufferers in order to understand how women discuss, experience, and form communities around it. It draws upon individual interviews, a focus group, and readings of medical and social science literature and found that women of dissimilar socioeconomic backgrounds approached and discussed the disease distinctively from one another with three phases of coping with the illness: the discovery, quest, and revelation.

Thesis (Ph. D.)--University of Chicago, Committee on Human Development, December 2003. / Includes bibliographical references. Also available on the Internet.

Drawing upon critical interpretive medical anthropology (Lock and Scheper-Hughes 1996) and Judith Butler’s (1990) concept of performativity, this thesis investigates the empowerment potential and effect on well-being of a community sewing group located in Saskatoon, Saskatchewan. This project was conducted using the methods of narrative ethnography, including semi-structured individual interviews, focus groups, and participant observation and finds that the Saskatoon Mothers’ Centre Sewing Circle contributes to well-being in three major ways. First, learning to sew shapes women’s self-perceptions, resulting in more capable, productive, and self-sufficient subjectivities. Learning to sew also enables women to act with more agency in their daily lives, empowering them through the opportunity to express identities, enhance social networks, and act within financial limitations. Finally, the Sewing Circle creates an environment of empowerment, an emotionally and physically safe space in which mothers are supported and nurtured, resulting in the formation of a supportive and encouraging community of practice. The Sewing Circle therefore supports women’s well-being by instilling them with the confidence and ability to act in their daily lives and to fulfill their potential. This research contributes to an understanding of the way in which sewing can contribute to the holistic well-being of older mothers by linking empowerment to performativity, and may contribute to the development of similar empowerment programming in the future.

In the United States, a growing proportion of the population is aged 65 and older. Associated with this demographic transition is a rise in the number of people who are aging with chronic disease. While there is a cultural ideal for older adults to remain in the community and out of institutional settings ("aging in place"), there is little recognition of the work and experience of trying to accomplish this. In the following papers, I draw on 12 months of ethnographic research in the Southwest US to describe the work of "aging in place." As a starting point, I use Medicare-funded home health care (HHC), which stands at the crossroads of acute-based institutional care and custodial, long-term care. In the first paper, using definitions of place from cultural geography, I explore the work of aging from the perspective of chronically ill older adult HHC users. I illustrate how bodies, practices, and places shift as processes of disease and medicalization inscribe them with risk, and the ways in which people accept, resist, and negotiate these changes. The second paper extends the work on audit culture to describe how Medicare's audit system has structured the organization and practice of HHC, and how this has reinforced the commodification of patients. I note how HHC nurses can draw on personal and professional logics in their documentation practices as a means of resisting rationalizing forces and opening up eligibility for care. The third paper uses case studies to push the literature on family caregiver burden to include the fraught, yet highly meaning-filled experience of caregiving. The cases show the difficulties and ambivalence in providing care to a chronically ill family member. Throughout these articles, underlying the tensions, uncertainties, and gaps I explore questions about what type of care is needed, who is worthy of care, and how responsibilities are distributed. I focus on how people's worlds and work are structured by larger scale social, cultural, and economic forces, and attend to the ways in which they reproduce, contend, and negotiate these forces from their unique positions, in effort to protect what they value.