Medical tourism is not a new phenomenon but in its current form, medical tourism or health travel is a practice that stems from the structures of the healthcare system. For citizens of countries with primarily private healthcare and citizens of countries with socialized healthcare the forces behind seeking international healthcare are economic (cheaper prices) and temporal (long queues), respectively. The foreign nation-state/patient relationship is an integral part in facilitating the medical tourist/hospital relationship and is also a way to discern discrepancies in welcomed versus unwelcomed visitors. On the one hand, medical tourists are welcomed visitors while other types of "tourists" are not. During my fieldwork as a volunteer at a private Costa Rican hospital, I was quickly made aware of the popular discourse that denigrated Nicaraguans entering Costa Rica while simultaneously catering to Euro-American tourists. This is a clear example of the discrepancy between neoliberal doctrine and neoliberal practices in that the free market promotes the transnational flow of capital while slowing or stopping altogether the flow of (certain) bodies. The United States and South Korea both issue special medical visas to medical tourists and these practices have thus far made international borders even more penetrable by the global elite and/or those with the capital to afford medical care in another country; thus graying the distinction between citizen and non-citizen. The means by which the medical tourism industry, from a marketing standpoint, attracts this global elite is through the accreditation process, which is the act of an accrediting body legitimizing a business, medical facility or school through an intense, expensive, and lengthy process. Within the medical tourism industry, hospitals located in developing nation-states are clamoring for accreditation from agencies based in the U.S. and Europe. Many in this industry believe that such accreditation will increase the number of foreign, primarily Western, patients. I argue that accreditation is a form of subjectification, because many international hospitals that cater to Western patients want to legitimize themselves through an American and/or European body even though their healthcare systems rank higher than the U.S. Accreditation makes international hospitals "qualified" to provide medical services in the eyes of Western medical tourists and the medical tourism industry as a whole, which underscores the quality and superiority of many healthcare systems in the developing world. The problems that I have undertaken is the discrepancy between neoliberalism and the flow of (certain) bodies and capital vis medical tourism and public policy as well as how accreditation is used as a form of surveillance, gaze, and subject making that renders hospitals nearly powerless to the standards set by accrediting bodies. / Anthropology

This dissertation focuses on an understudied population of people with severe and chronic skin disorders concerning their lived realities in mainstream and specialized settings. Little is known about the life experiences of this population that, because of the rarity of these largely inherited disorders, is demographically scattered throughout North America. Through descriptive narratives from an individual perspective, the aim of this research is to educate others as to how people with severe and chronic skin disorders shape their identities, often as disabled, and experience daily life. Research participants include forty-four men and women, ranging in age from eighteen to seventy-plus years, who attended at least one of four week-long camp programs for children with severe and chronic skin disorders in the summer of 2009 at varied locations in the United States. Ethnographic research methods include participant-observation, face-to-face and telephone interviews to glean life narratives, and questionnaires for demographic and statistical analysis. Interview data are assigned to four categories: 1) Those with skin disorders who did not attend a childhood camp designed specifically for children with skin disorders, 2) those who did attend a skin disorders camp as a child and are now staff at such camps, 3) medical personnel who are camp staff, and 4) adult camp staff attendees who are not medical professionals nor any diagnoses of severe or chronic skin disorders. Through the ethnographic process themes evolved, including the effects of socially constructed markers of race, gender, age, and extent of disability, that further impact individuals' experiences of life in both the camp and mainstream settings. All persons with skin disorders interviewed report negative effects from stigmatization to a varying degree in mainstream society, while four report adverse experiences in the camp setting. All participants with skin disorders interviewed report that camp programs for children with skin disorders have positively impacted their lives in both mainstream and camp settings. Additionally, all medical personnel interviewed report positive, life-changing experiences and a new understanding of how people with skin disorders experience daily life. This dissertation also addresses the role that the social institution of biomedicine plays in the creation of camps for children with severe and chronic skin disorders, as well as how the relationships of biomedical practitioners and adults with skin disorders at camp change the perceptions of each other. Ultimately, it is the overt goal that this dissertation educates all readers with respect to how people with skin disorders are often labeled as being disabled and suffer consequences of stigmatization related to disability, as well as increase awareness of how mainstream society affects the identities of this particular population. / Anthropology

No description available.

The main goal of this study, in the field of the Anthropology of Policy, was to analyze the social construction of the AIDS vulnerability of truck drivers in the South of Brazil, examining the national HIV/AIDS prevention policies. The discourse of three social actors were analyzed using the Medical Anthropology framework: (i) the national gonvernmental AIDS agency, (ii) the Non Governmental Organizations supported by the National AIDS Program to execute prevention projects targeting truck drivers, and (iii) the truck drivers themselves, passing through Rio Grande do Sul state. Three important themes traverse this study: (i) globalization (and the global/local relations), (ii) the identity of a social group or a community, and (iii) the construction of a sexual culture. To understand the social construction of the truck drivers’ vulnerability, I followed the route that this idea went through different institutions and levels. Beginning at international intergovernmental agencies such as the World Health Organization, the United Nations AIDS Program (UNAIDS) and the World Bank, the course followed through the analysis of scientific research on the theme, and finally the national AIDS agency’s discourse. The route finally came to how NGOs seize and use the idea that truck drivers are a vulnerable group, ending with how the truckers themselves perceive their vulnerability to HIV, AIDS and sexually transmitted infections. The study was limited in scope by the action of NGOs who had developed publicly funded projects targeting truck drivers. Methodologically, the study collected and analyzed data of different origins, types and qualities. Official documents, grey literature, scientific papers on truckers and HIV/AIDS, as well as NGO project proposals were studied. Data collection also involved an ethnography and a survey (N=854) of truck drivers. Both qualitative and quantitative studies of truckers were developed in Rio Grande do Sul, southernmost state of Brazil, in the cities of Porto Alegre, Gravataí, Canoas, Rio Grande and Chuí. Truckers are immersed in a social network, both in the truck stops (fuel stations and customs) and in their places of origin (where family relations prevail). The social universe of the truckstops is not a simply a transitory place: there are rules of conduct, leaderships, social spaces which are symbolic and geographically marked, and a number of persons who maintain diverse relations amongst themselves for a long time. Truck drivers did mention inconsistent use of condoms, specially with regular or fixed partners, that certainly increases their vulnerability to HIV and sexually transmitted infections. However, inconsistent condom use, and the availability of commercial sex workers, is not exclusive to truckers or truck stops. Emphasis is given to the programmatic or institutional vulnerability of truck drivers.

This mixed methods research was conducted in the fall of 2014 to understand the perceptions and experiences of health risks and health outcomes due to pesticide exposure among community members (n=13) - concerned community members, agriculture workers and teachers- that live in the Central California agriculture counties of Monterey, Santa Cruz, Tulare, Fresno and Madera. This research explored: 1) The crops growing in participants’ communities, and how exposure to pesticides used in these crops pose potential health risks to participants and their communities 2) How pesticide exposure is impacting Hispanic/Latino communities in Central California, particularly those that are most vulnerable including school children, agriculture workers, and community members 3) The major public health concerns of impacted communities 4) Feelings of empowered to advocate for community health and environment and 5) What impacted communities wish to see on behalf of government and agribusiness to protect public health from pesticide exposure and toxins.

Kenyan informal settlements have been thoroughly depicted by previous researchers as biophysical, epidemiological, and economic risk environments in which food insecurity is recognised as one of the most persistent everyday challenges. Although unemployment and illness are key contributors to the inability to purchase sufficient food, the reasons why households experience food insecurity are more complicated and not fully understood. Part of the problem is that few previous studies have privileged socio-political contributions (e.g. gender-based power inequalities and the impacts of social networks) to household food security risk. Whilst food security researchers commonly utilise the concept of vulnerability to address household-scale risk, this concept is rarely applied to interpersonal dynamics within households. Using data gathered through participant observation, questionnaires, and 109 in-depth interviews with 67 participants, this thesis provides an ethnographic account of household food insecurity in an informal settlement which addresses three primary questions: (1) In what ways might interpersonal relationships within households contribute social and political obstacles to achieving food security? For instance, how and why might risk for food insecurity emerge from experiences of interpersonal conflict? (2) What role do extra-household social networks play in experiences of food security within households? (3) How useful is the concept of vulnerability for addressing experiences of risk which are negotiated between household members? In the informal settlement of 'Bangladesh', Mombasa, Kenya, conflict within domestic, especially conjugal, relationships represents a potential source of risk to food security for individual members or entire households. Contributing to this conflict are gender inequality, power differentials, the failure to meet marital expectations, and how people respond when presente with risk. Resulting experiences of food insecurity are shown to contribute to further conflict in the household, thereby creating a cycle of conflict and food insecurity. Those who find that they have insufficient food at home may receive assistance (food or money) from members of their social networks. However, these relationships may also contribute to experiences of conflict, and therefore insecurity, within households. Applying concepts of vulnerabilty to account for experiences of risk and their consequences (food insecurity) requires differentiating between what represents a hazard, a response, and an outcome. Within multi-person households, it is exceedingly difficult to divide lived experiences involving interpersonal conflict among these three categories. Thus, I argue that vulnerability is less useful for research concerning intra-household dynamics than it is for studies which assume households to be undifferentiated units.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Cette recherche analyse une pratique, née de maladies qui n’ont pas trouvé de réponse dans le domaine biomédical. Elle constate que le manque de sens ou un sens très péjoratif à la maladie induit un désordre intérieur qui est assimilé au « chaos ». Ce néant de nos origines a été à l’origine des mythes cosmogoniques et des religions antiques qui constituent la première mise en ordre du monde dans toutes les civilisations humaines. La mort, le plus grand désordre du parcours humain, et tout ce qui lui est assimilé comme situation, ramènent en chaque individu ce chaos et l’angoisse de néantification qui lui est indissociable, à travers la perturbation de ses liens. C’est ce qui s’exprime dans les manifestations psychosomatiques et les maladies « surnaturelles ». La remise en ordre proposée dans cette pratique s’appuie sur l’humain, être de lien et de symbole, qu’il faut rétablir à la fois sur le plan individuel et collectif. Elle s’inspire de la culture malgache et de son rapport aux ancêtres. Cette thèse veut contribuer à combler la rupture entre la culture scientifique et celle des humanités par la naissance d’une discipline frontière : l’anthropomédecine. / This research analyses a practice, born from diseases that didn’t find any answers in the biomedical field. It notices that the lack of sense or a very pejorative sense attributed to the disease results in an inner disorder which is likened to « chaos ». This void of our origins has been the roots of cosmogonic myths and ancient religions which constitute the first tidying of the world in all human civilizations. Death, the biggest disorder of human history, and any situation likened to it, bring back inside each individual this chaos and the anguish of self nihilation that is indivisible from it, through the disruption of its bonds. This is what is expressed in the psychosomatic demonstrations and the « supernatural » diseases. The tidying proposed in this practice leans on the human being, individual of bond and symbolism, which needs to be re-established individually and collectively speaking. It draws its inspiration from Malagasy culture and from its connection with the ancestors. This thesis aims to contribute to fill the breach between the scientific culture and the humanities’ one by giving birth to a boundary discipline: anthropomedicine.

O câncer de próstata (CP) é a neoplasia maligna mais incidente entre os homens brasileiros, principalmente na região sudeste do país, depois do câncer de pele não melanoma. Os sinais, sintomas e tratamentos da doença afetam o adoecido gerando momentos de sofrimentos, medos e incertezas diante do seu prognóstico. Esta pesquisa teve como objetivo interpretar os significados atribuídos à experiência dos homens adoecidos com o CP, seus tratamentos e complicações com base na concepção antropológica de masculinidades. Para atingir este propósito um estudo qualitativo foi realizado e adotado o método da etnografia narrativa e o referencial teórico da Antropologia Médica e das Masculinidades. Participaram do estudo 17 homens diagnosticados com CP em seguimento terapêutico em um hospital universitário localizado no interior do estado de São Paulo. A coleta de dados foi realizada de forma individualizada com cada participante por meio de entrevistas em profundidade e observação do contexto de pesquisa , sendo estas registradas em diário de campo, realizada nas dependências do complexo hospitalar e nos lugares em que os participantes julgavam propícios para conversar sobre sua experiência. A captação dos dados ocorreu entre o período de março de 2013 a março de 2016. Foram construídas sínteses narrativas individuais e em seguida sínteses narrativas coletivas para melhor compreender as experiências narradas. Em seguida, os enredos foram submetidos a análise temática indutiva e os aspectos semelhantes e particulares das narrativas foram integrados e apresentados sob forma de duas sínteses narrativas temáticas, denominadas: Enredos corporificados do câncer de próstata: normas, conflitos e descobertas, onde são apresentadas crenças, costumes e valores atribuídos ao corpo do homem na sociedade e em sua cultura, as normas hegemônicas que regem à sua forma de lidar com o seu itinerário terapêutico, transformando o seu corpo um lócus de agência e objeto de sentidos durante o adoecimento, os quais nos permitiram atribuir a esta síntese o significado de corporeidade; e Masculinidades resignadas em tempos de crise: como nos vemos, enfrentamos e seguimos no nosso mundo social que aborda as transformações ocorridas sob o corpo social e biológico apresentados pelo homem por meio da perda da identidade masculina hegemônica e adoção de outras masculinas, onde o homem que era forte, potente e viril deu lugar para o homem dependente, fraco e isolado que lida com as adversidades da doença e com o seu agenciamento por meio da resignação do seu corpo e de suas práticas. Assim, esta síntese narrativa temática teve por significado a transição de identidade. Os sentidos destas experiências foram discutidos com o auxílio de conceitos da antropologia e suas interpretações que nos permitiram explicar compreensivamente que a cultura influencia diretamente na forma como o homem lida com o CP e suas masculinidades durante o adoecimento. Destacamos a importância do enfermeiro apreender a experiência do adoecido, numa perspectiva ampla que relaciona o homem, suas masculinidades, sua cultura e seus significados / After non-melanoma skin cancer, prostate cancer (PC) is the most malignant neoplasms incident among Brazilian men, mainly in the South-East region of Brazil. The signs, symptoms and disease treatment affect the patients generating moments of suffering, fear and doubt about his prognosis. The aim of this research was to interpret the meaning attributed to experience of the patients (men) with PC, their treatments and complications based on anthropological perspective of masculinities. To achieve research objectives it was used qualitative study supported by method of the ethnographic narrative and Medical Anthropology and Masculinities Theories. This study had the participation of 17 men diagnosed with PC under therapeutic follow-up in the university hospital located on the countryside of São Paulo state. The data collection was individual with each participant through deep interviews and observations of the research context. The information was registered in a field diary in the hospital and others appropriate locals suggested by participants to talk about their experience. The data were obtained in the period from March 2013 to March 2016. Both individual narratives syntheses and in the sequence collective narratives syntheses were built to achieve the best comprehension of the experience told by patients. After this step the stories were analyzed under inductive thematic and similar and specific aspects were integrated and presented by two thematic narrative syntheses denominated: Embodied narrative of the prostate cancer: rules, conflicts and discovery which present beliefs, custom and values attributed to man´s body in the society and his culture as well as hegemonic rules that guide his way to handle with therapeutic itinerary, turning his body into a locus of agency and object of sense during the process of the disease that allowed us to attribute to this synthesis the meaning of embodiment; Masculinities resigned in the crisis period: how see ourselves, how to face and act in our social world that approaches the transformation occurred in the body in social and biological terms presented by man through of his loss of the hegemonic masculinity identity and adoption of others masculinities; the change from strong, potent and virile man to dependent, weak and alone one that deals with disease adversity and its agency through his resignation with the body and practices. Thus, this thematic narrative synthesis had as meaning the transition of identity. The senses of these experiences were discussed under concepts of the anthropology and its interpretations that allowed us to explain comprehensively that the culture influences directly the manner that the man handles with PC and his masculinity during the process of disease. We underline the importance of the nurses apprehend experience of the patients under wide perspective that include the man, his masculinities, culture and its meanings

Os grupos de educação em saúde têm sido considerados espaços nos quais se produz intervenções educativas, cujo objetivo último é a aderência ao tratamento. Isto se faz por meio da valorização do saber médico e da assunção da ignorância do sujeito que adoece. No Brasil, há poucos estudos antropológicos de grupos de diabéticos que se realizem dentro de serviços oficiais de saúde. Esse tipo de abordagem tem-se mostrado pertinente, uma vez que a experiência com a doença crônica está intimamente entrelaçada com os tipos de serviços e de profissionais de saúde que eles encontram no sistema oficial de saúde. Este estudo partiu do pressuposto de que em tais grupos é possível analisar as formas de operação do modelo terapêutico para diabetes tipo 2. Buscou-se apreender os grupos como instâncias produtoras de sentidos e de significados relativos ao processo de adoecimento. Portanto, teve-se como objetivo compreender os aspectos discursivos, estruturais e simbólicos que compõem os modos de operação do modelo terapêutico para gerenciamento do diabetes tipo 2 em grupos de educação em saúde na atenção básica. O trabalho de campo foi conduzido entre os meses de agosto/2011 e setembro/2012 num centro de saúde em Campinas-SP. Participaram do estudo 58 indivíduos, entre usuários, profissionais e gestores. Desse total, 33 foram entrevistados individualmente ou nos grupos de discussão. Nesse contexto, o gerenciamento do diabetes tipo 2 dá-se por meio de tecnologias e ética do autocuidado que exigem dos indivíduos autocontrole, automonitoramento e disciplina. Destaca-se o seguinte: os itinerários dos pacientes até o ingresso nos grupos; os ditos e cochichos nas reuniões; as negociações no acompanhamento clínico; os significados atribuídos aos grupos que, em alguma medida, se contrapõem e se retroalimentam; os usos sociais dos grupos; os sistemas de privilégios e gradações existentes entre os participantes; os compartilhamentos e trocas de experiências e saberes socializados na lida diária com a enfermidade crônica; as críticas e sugestões que os informantes fazem ao modo de funcionamento dos grupos, apesar de tímidas ou intimidadas; o papel do vínculo e das relações como elementos que conferem eficácia simbólica ao ato médico e à educação em saúde. Diante disso, observa-se a existência de uma crise no modelo de educação em saúde vigente. Além disso, chama-se a atenção para a lógica cultural que opera nesses grupos, o que evidencia as diferenças e complementaridades entre as dimensões técnica e relacional do cuidado, como reflexos dos referentes culturais e valores sociais da sociedade brasileira mais ampla. / Health education Groups have been considered spaces where produces educational interventions, whose ultimate objective is adherence to treatment. This is done through the enhancement of medical knowledge and the assumption of ignorance of the people who gets sick. In Brazil, there are few anthropological studies about these groups that take place within the official health services. This approach has shown relevant, since the experience with chronic illness is closely intertwined with the types of services and health professionals they encounter in the public health system. This study was based on the assumption that such groups can examine ways of operating the therapeutic model for type 2 diabetes. It tried to apprehend these groups as instances of producing senses and meanings related to the disease process. So we had as objective to understand the discursive, structural, and symbolic aspects that make up the operating modes of the therapeutic model for management type 2 diabetes into health education groups in primary health care center. Fieldwork was conducted between the months of August/2011 September/2012 in Southeast Brazil. The study included 58 individuals (patients, professionals and managers). Of this total, 33 were interviewed individually or in focus groups. In this context, the management of type 2 diabetes occurs by means of technology and ethics of self-care of individuals requiring self-control, self-monitoring and discipline. It highlighted the following: the itineraries of patients until entry in groups; the \"uncertain\" and \"whispers\" in meetings; negotiations clinical follow; meanings assigned to groups, to some extent, oppose and feed back; the social uses of the groups; systems of privileges and gradations between participants; shares and the exchange of experiences and knowledge in deals with chronic illness; criticism and suggestions that informants make the workings of groups, despite the \"shy\" or \"intimidated\", the role of the bond and relationships as elements that confer symbolic efficacy to the medical act and health education. Thus, we observe the existence of a crisis in the health education model. It demonstrates the differences and complementarities between the technical and cultural/relational dimensions of care reflecting the cultural reference points and social values of the broader Brazilian society.