Building on research conducted over the last ten years, this dissertation explores how local understandings and manifestations of gender violence are changing as women and men learn about human rights and gain access to state-based forms of justice. Wife abuse in coastal Ecuador is often explained as a result of machismo and an enduring culture of violence. I challenge this conception by demonstrating how political, economic and social processes normalize gender violence, and by showing how transnational human rights discourses are reshaping gender relations, structures of impunity, and the visibility of particular forms of violence. Inhabitants in this historically marginalized region are using alliances with transnational NGOs to negotiate their relationship to the state. Human rights, transnational alliances, and improved access to justice offer powerful openings for local women and families, but their empowering potential is delimited by growing social and economic vulnerability and the discrepancies between rights-based subjectivities and preexisting understandings of the self. Ultimately, I argue that human rights - as concept, as practice, and as discourse - reorganize power in ways that warrant both optimism and critique.

Bakgrund: Suicid är ett folkhälsoproblem och i Sverige suiciderar cirka 1400 människor varje år. Sorgen efter en närståendes suicid leder till en kris och ett lidande för de anhöriga. Sjuksköterskans roll i den vårdande relationen blir att bekräfta dessa känslor och upplevelser hos den anhöriga. Syfte: Beskriva anhörigas upplevelser om hur lidandet kan lindras i sorgen efter en närståendes suicid. Metod: Studien är en kvalitativ analys av berättelser där tre självbiografier, tre antologier samt en rapport analyserades utifrån ett omvårdnadsperspektiv. Resultat: Resultatet visade tre kategorier med utgångspunkt från att lindra de anhörigas lidande. Att ta avsked av den döde visade sig vara viktigt i sorgeprocessen men att ändå vara lyhörd för individens val var viktigt. De anhöriga upplevde en unik känsla i sorgen efter en närståendes suicid och hade ett stort behov av att bli bekräftade i detta från omgivningen. Till sist hade de anhöriga skiftande behov av stöd i att leva vidare som kunde innefatta både läkemedelsbehandling, samtalsstöd och hjälp i det vardagliga. Slutsats: Genom resultatet kan studien belysa sjuksköterskans roll i den vårdande relationen som är att se och bekräfta de anhöriga som unika individer och fungera som koordinator gentemot den anhöriga med övriga hälso- och sjukvården. / Background: Suicide is a public health problem and each year about 1,400 people commit suicide in Sweden. The grief after a loved one's suicide leads to a crisis and suffering of the survivors. The nurse's role in the caring relationship is to confirm the survivor’s feelings and experiences. Purpose: Describe suicide survivors’ experiences of how suffering can be alleviated after a loved one's suicide. Method: The study is a qualitative analysis of three autobiographies, three anthologies and a report, which were analyzed from a nursing perspective. Results: The result showed that saying goodbye to the deceased was important in the grieving process but also sensitivity to each survivor’s choice was paramount. Survivors experienced a unique feeling of grief after a loved one’s suicide and had a great need to be confirmed in this. Finally, the survivors had varying needs of support in order to continue living, which could include medical treatment, counseling or assistance in the everyday life. Conclusion: The results highlight the nurse's role in the caring relationship where acknowledging the survivors as unique individuals and coordinating their needs where among the nurse’s main tasks.

Permission from the author to digitize this work is pending. Please contact the ICS library if you would like to view this work.

This paper was revised and later published in The Other Journal, Issue 14 (January 27, 2009) http://theotherjournal.com/2009/01/27/earths-lament-suffering-hope-and-wisdom/ Accessed: June 25, 2013

This is a revised version of Lambert Zuidervaart's inaugural address presented on November 21, 2003, on the occasion of the author's taking up the position as professor at the Institute.

The thesis takes as its starting point the importance of community in contemporary political societies across the world, most notably, for present purposes, the Third World. Community importantly determines questions of social inclusion, exclusion, identity, belonging and well-being. As is no surprise, the role and significance of community is well recognised in several academic disciplines today. Consider this one example. Recent literature on development has generally drawn attention to the potential benefits of participation in certain aspects of governance. More specifically, proposals for community participation have emerged in response to State failure, or now the pervasiveness of market exclusion. Community participation is motivated by several grievances, the most emphatic of which is the profound gap between the lived experiences of the poor and institutions that affect their lives. This gap between discourse and lived experience is more vividly evident in human rights practice, and this not only reflects the dominance, but also the inadequacies of State and market-based understandings alike. A fundamental aspect of this debate – largely overlooked by human rights discourse – is the role of community. Whilst there remain marginal references to community in certain aspects of human rights discourse, over all it has not sufficiently or comprehensively embraced community. More specifically, the Declaration of Right to Development, Rights-Based Approaches to Development and the World Bank‘s concept of good governance fail to offer an adequate role for community in human rights terms. Drawing from a range of literature in legal theory, political theory, philosophy and sociology, and developing its insights in the context of the supply of the – human right and – public good of electricity in Nigeria, the thesis offers a theory of community, which seeks to enable individuals, particularly, the poor and vulnerable, to organise themselves democratically, to claim ownership of the processes that determine their human rights.

In this thesis I analyse the reporting and the reception of news about distant suffering in the light of John Howard Yoder‘s work on witness. Studies of news reporting about foreign wars, genocide and disasters commonly conclude that the practice of bearing witness to distant suffering contributes to a context where both journalists and spectators appear to have limited moral agency. I argue that the practice of bearing witness has ethical significance for those actively engaged in bearing witnessing. In his work on Christian witness, Yoder demonstrates how witness can be understood as a method for moral reasoning. I assert that Yoder‘s argument presents a fruitful approach for interdisciplinary consideration of the ethical significance found in the practice of bearing witness to distant human suffering. In chapter one, I lay the foundation of my investigation into the ethical agency involved in bearing witness. John Howard Yoder‘s theological approach to social ethics provides that foundation. Central to Yoder‘s claim that witness is a form of ethics, is the premise that presence testifies. Yoder calls this the 'phenomenology of social witness‘. Yoder‘s work opens new ways in which to ask questions about the practice of bearing witness as a form of social ethics. It is from this foundation that I begin to ask questions about the news media practice of bearing witness to distant suffering, the subject of chapter two. Media practices are social practices that involve a dense interaction of many layers of society. In the media practice of witnessing distant suffering, governments, charities, news media organisations, and audiences are all involved in what I call the social formation of the Global Samaritan. The foundational work on Yoder in chapter one allows me to ask the question: How is the Global Samaritan a presence, and to what does this presence testify? In chapters three and four, I focus on two of the prominent groups which contribute to the formation of the Global Samaritan: audiences and foreign correspondents. News audiences as moral agents already seem a problem for Yoder‘s claim that presence testifies. Do audiences who bear witness to distant suffering have moral agency? How can the amorphous and fleeting presence of television, internet, or twitter audiences testify? In the chapter on audiences, the initial claim regarding presence makes for an important investigation into how audiences can potentially move beyond mere spectatorship and towards participation in care for the suffering. Foreign correspondents bearing witness to distant suffering do not face the same obstacles to testifying as audiences do. After all, foreign correspondents are often live, on-the-scene of extraordinary circumstances of suffering. The danger and risks foreign correspondents face in order to report live from scenes of devastation and disaster testify to the fact that the situation is indeed dangerous and causing suffering. Yoder‘s claim that presence testifies is a claim strongly paralleled within the tradition of investigative journalism. In chapter four, I investigate the ethical function of foreign correspondent presence. I consider the foreign correspondent‘s dual role as the proxy 'eyes and ears‘ of the public and the proxy voice for those without a voice. Through these two roles, I explore major concepts involved in the practice of investigative journalism. One prominent issue I explore is the tension between the principles of a liberal democratic press and the practice of frontline reporters live, on-the-scene of extraordinary and extreme situations. In the final chapter, chapter five, I focus on the experience of three frontline reporters bearing witness to human suffering. BBC [British Broadcasting Company] reporter John Simpson‘s reflections on his coverage of the beginning of the Iraq War illustrate the importance of bearing witness as involving real presence on location. Norwegian freelance reporter Ǻsne Seierstad‘s reflections on covering the Iraq War from Baghdad further contributes to the concept of 'being there‘ as central to bearing witness. Focus on Seierstad also furthers discussion on women reporters bearing witness to war. The third reporter I highlight is BBC reporter Fergal Keane. I focus on his reflections covering the Rwandan genocide to illustrate how the claim to bearing witness involves more than spectatorship, but often involves participation. I conclude with an analysis of the media practice of bearing witness, involving the range of reporter presence to the quasi-presence of the audience, in the light of John Howard Yoder‘s claim that bearing witness is a form of social ethics.

Endometrios är en kronisk sjukdom som drabbar 10–15 procent av alla fertila kvinnor. De vanligaste symtomen är bäckensmärta, menssmärta, samlagssmärta, kraftiga blödningar, infertilitet, förstoppning och diarré. Då symtomen oftast är diffusa och kunskapen om endometrios inom sjukvården är bristfällig tar det mellan 8–11 år från det att kvinnan sökt vård för sin smärta till att diagnosen är fastställd. Syftet med studien var att beskriva livslidande hos kvinnor med endometrios. Studien genomfördes som en integrativ litteraturstudie, vilket ger en djupare förståelse och en mer heltäckande bild av ett visst fenomen. Kvinnorna beskrev sitt livslidande genom att det är bristande förståelse och kunskap om sjukdomen. Detta upplevde de särskilt ifrån vården, familj, vänner, kollegor och partners. Kvinnornas livssituation och fysiska funktioner var begränsade på grund av sjukdomen, detta påverkade det dagliga livet. Utanförskapet var framträdande och att fungera i ett socialt sammanhang var svårt vilket blev till ett livslidande. Det innebar också ett livslidande att leva med ovisshet och oro inför framtiden, där det största bekymret handlade om svårigheter med att bli gravid och att få behålla barnet. En slutsats var att distriktsköterskor bör bli bättre på att uppmärksamma kvinnor med endometrios och tro på deras sjukdomsupplevelser. Mer forskning behövs för att belysa livslidandet hos kvinnor med endometrios och därmed öka kunskapen om hur distriktsköterskor kan bemöta dessa kvinnor. / Endometriosis is a chronic disease that affects 10-15 percent of all women of childbearing potential. The most common symptoms are pelvic pain, menstrual pain, intercourse pain, heavy bleeding, infertility, constipation, and diarrhea. Where symptoms are often diffuse and the knowledge of endometriosis in health care is poor, it takes between 8-11 years from the woman sought treatment for their pain at diagnosis is confirmed. The aim of the study was to describe life-suffering in women with endometriosis. The study was conducted as an integrative literature review, which provides a deeper understanding and a more complete picture of a phenomenon. The women described their life-suffering by it´s lack of understanding and knowledge about the disease. They experienced it particularly from the health care, family, friends, colleagues, and partners. Women's lives and physical functions were limited because of the disease, which affected the daily life. Many women experienced exclusion, having a social life was difficult which lead to a life-suffering. To live with uncertainty and anxiety about the future was also life-suffering, where the main concern was about the difficulties in becoming pregnant and to keep the baby. One conclusion was that district nurses should be better able to pay attention to women with endometriosis and belief in their illness experiences. More research is needed to elucidate the life-suffering of women with endometriosis and thereby improve knowledge about how district nurses best can meet these women.

Essa pesquisa buscou identificar a representação sobre a dor dos enfermeiros docentes do ensino médio, e sua relação com o processo de ensino-aprendizagem sobre o assunto, tanto na teoria quanto na prática da assistência de enfermagem. Metodologicamente, a pesquisa teve abordagem qualitativa. O estudo foi realizado em uma escola técnica na zona norte de São Paulo. Foram realizadas 12 entrevistas semiestruturadas, com enfermeiros docentes, observações em sala de aula, em cujo planejamento constava o ensino da dor. Esta etapa teve como objetivo observar a estratégia de ensino-aprendizagem da dor. O estudo revelou que, para os enfermeiros investigados, a dor representa sofrimento. Dois aspectos ajudam a entender essa associação: o primeiro refere-se à desvalorização profissional no ambiente de trabalho. Nas entrevistas, a desvalorização apareceu associada à dor com regularidade. O segundo aspecto refere-se à ingratidão dos pacientes. A maioria dos entrevistados demonstrou que a ausência de gratidão por parte dos pacientes lhes causa dor. Diante da dor em suas diferentes dimensões física, moral e social, o enfermeiro mobiliza sua bagagem cultural e profissional. Enquanto a dor física é tratada com antálgicos, a dor da desvalorização social é enfrentada com investimentos na formação profissional. É possível observar uma relação clara entre a representação sobre a dor pelo enfermeiro docente e o processo de ensino-aprendizagem sobre a dor. Ancorados nessas representações, as estratégias de ensino utilizadas pelos enfermeiros docentes são, na sua maioria, aulas expositivas, dialogadas, com auxílio de slides, bastante semelhantes com a maneira pela qual o enfermeiro docente relata ter aprendido na graduação. Sobre avaliação da dor, as ferramentas mais utilizadas são prova escrita, chamada oral, apresentação de trabalhos em grupo e seminários. Os enfermeiros revelam ter dificuldade em avaliar o aprendizado sobre dor devido à subjetividade do tema. Conclui-se que o fato da dor representar sofrimento para o enfermeiro docente faz com que o assunto seja evitado, ao mesmo tempo em que o profissional se sente desmotivado para ensinar algo que não lhe causa boa sensação. Essa representação sobre a dor interfere em todas as etapas do processo de ensino-aprendizagem, podendo acarretar prejuízo na formação do técnico de enfermagem em relação ao cuidado dos pacientes com queixa de dor / This research aimed at identifying the representation on the pain by High School teaching nurses, and their relationship with the learning-teaching process of the issue, in relation with both the nursing assistance theory and practice. Methodologically, the research had a qualitative approach. The study was conducted in a technical school in São Paulos North Region. There were 12 semi-structured interviews with teaching nurses, and classroom observations in classes whose planning included teaching about pain. This step was aimed at observing the teaching-learning strategy of pain. The investigation shows that, for the nurses investigated, the pain stands for suffering. Two aspects help us understand this association: the first relates to the professional devaluation in the workplace. In the interviews, the devaluation was associated to the regular pain. The second relates to the ingratitude of patients. Most of the interviewees has demonstrated that the absence of gratitude of patients causes them pain. In front of the pain in its physical, moral and social dimensions, the nurse mobilizes his/her cultural and professional background. Whereas the physical pain is treated with analgesics, the pain caused by social devaluation is addressed with investments in professional qualification. It is possible to remark a clear connection between the teaching nurses representation on pain and the teaching-learning process of the pain. Based on these representations, the teaching strategies used by the teaching nurses, mostly dialogic, slides-based lectures, are quite similar to the ones by which the teaching nurse him-/herself reports to have learned in his/her undergraduate course. On the pain assessment, the most used tools are written and oral tests, group works and seminars. The nurses report difficulties in evaluating the learning about the pain due to the topics subjectivity. The conclusion is that the pain standing for suffering for the nurse leads to the topic being avoided, as well as the professional being unmotivated to teach what does not cause him/her a good feeling. This representation on the pain interferes in all the teaching-learning process steps, which is likely to undermine the nursing technicians qualification in the care of patients complaining of pain

Este estudo teve o propósito de compreender como os profissionais de saúde constroem o significado do sofrimento do paciente oncológico, segundo suas experiências. A investigação foi desenvolvida segundo as propostas da antropologia interpretativa de Clifford Geertz, a antropologia médica de Arthur Kleinman e no conceito de sofrimento de Morse. A amostra constou de doze profissionais, membros da equipe interdisciplinar que atuam com pacientes oncológicos. Os dados foram coletados por meio de entrevistas semi - estruturadas e de observações participantes, no contexto sociocultural hospitalar. A análise dos dados foi realizada segundo os pressupostos referencial metodológico de narrativas. Com as experiências relatadas pelos informantes foi possível compreender que os significados do sofrimento do paciente oncológico são construídos segundo os sistemas de cuidado cultural profissional e não profissional. O estudo levou a compreensão de que a experiência de sofrimento do paciente pelos profissionais leva a construção de significados comuns, integrados em temas que destacam a empatia, a emoção, o conflito, a individualização dos papéis, as estratégias de intervenção e que estão embasados nos conhecimentos culturais dos profissionais. / The purpose of this study was to understand how health professionals construct the meaning of oncology patients suffering based on their experiences. The research was conducted according to the Clifford Geertz proposal of interpretative anthropology and Arthur Kleinman medical anthropology and Morse?s suffering model. The sample was formed by twelve professionals, members of an interdisciplinary team that work with oncology patients. Data were collected through semi-structured interviews and participant observation at a hospital socio-cultural context. Data analysis was performed according to the presuppositions of the narrative method. Based on the experiences of suffering reported by the professionals, the author understood that the meanings of suffering to the oncology patients are constructed according to the professional and non-professional cultural care systems. The author concluded that the experience of suffering results in common meanings, integrated in themes such as empathy, emotion, conflict, role individualization, intervention strategies and that they are based on the professionals? cultural knowledge.