This thesis is an investigation into the socio-economic constraints that influence the decisions of tuberculosis sufferers in the health seeking process and therapeutic management of tuberculosis in Grahamstown, the Eastern Cape. It is shown that structural violence influences experiences and perceptions of tuberculosis at all levels. Management of tuberculosis in the formal health sector is explored at local levels and related to national and global strategies of health care. The role of health workers, and particularly voluntary health workers, is explored and it is shown that they work within a context of growing burden of sickness and co-infections and a lack of government commitment to deal with increasing TB and HIV incidences. Kleinman’s notion of explanatory models is explored and it is evident that although knowledge of the aetiology of tuberculosis is well-known to patients and general members of the communities, they are nevertheless victims of increased stigmatisation and marginalisation as a result of illness. The importance of social support in curing tuberculosis is explored using Janzen’s concept of therapy managing groups. Social capital is a fundamental component in adhering to biomedical therapy, but is commonly weak among the structurally poor. The availability of temporary social grants for people living with TB influences health seeking behaviour. In a context of structural poverty the sick are faced with what Nattrass terms “perverse incentives”, having to choose between the right to health and the right to social security, both guaranteed in the South African Constitution, for him/herself and dependants. Although adherence to biomedical therapy is essential in curing tuberculosis, it is shown throughout this thesis that ignoring wider structural causes of disease limits the patient’s ability to get well. The ethnography shows that the right to health is a social and economic right which is not the reality for most South Africans.

Increasing numbers of medicines are being used by pregnant South African women in the public sector during pregnancy, for the treatment of different biomedical and supernatural disease states and conditions. The motivation for the research is to support the development of more local pregnancy registries in order to strengthen evidence for the safety and efficacy of medicines used in pregnancy. A mixed methods approach was used. Women in their ninth month of pregnancy in a public sector setting, and four community pharmacists were identified. The women who met the inclusion criteria were recruited. One in-depth semi-structured interview was conducted with each woman before giving birth and data on their pregnancy outcomes were collected after labour. Coincidentally, the mother of one of the participants was found to be a traditional healer. She was also interviewed on the topic. A structured questionnaire was administered to the pharmacists. Ten pregnant women between the ages of 19 to 39 who had used or were using a traditional medicine during the pregnancy were recruited. All the participants had had at least one antenatal check up during their pregnancy with one having attended five times. No abnormal results were reported from any of the check ups or tests done during the visits. All of them had been to school and had at least Standard 8/Grade 10 education. Ten babies were seen between one and four days postpartum and no birth defects were obvious or were reported for any of them. The traditional healer did not provide additional information to what the women had said and confirmed that some of the practices the women reported were known to her as traditional medicine practices. All four pharmacists indicated that they considered complementary and alternative medicines (CAMs) to be “somewhat effective” and sold them at their pharmacies although none of them were aware of whether or not they were registered with the MCC. None of the pharmacists appeared to have an in-depth knowledge of traditional, complementary and alternative medicines (TCAMs). All four pharmacists said that it is important to have a basic understanding of TCAMs before using them, although they did not agree on the reasons for this. All of them felt that pharmacists have a professional responsibility to provide information on TCAMs (especially herbal preparations) and two felt that providing this information is part of a medical doctors’ responsibility. No harm from taking TCAMs could be shown. However herbal medicines have numerous ingredients some of which are unknown and taking these medicines is risky. The pharmacists in this sample were unsure whether they were accessing unreliable CAM information. Reliable sources of information and reference materials on CAMs to assist pharmacists and other healthcare professionals are needed. The apparent widespread use of TCAM in pregnancy indicates a need for documentation about its efficacy and safety. The establishing of TCAM pregnancy registries should seriously be considered. Due to the increase in CAM use, CAM education during pharmacists’ training as well as continuing professional development (CPD) in CAM for pharmacists in practice should be encouraged.

Global health organizations attend to populations around the world applying an evidence-based model of care that often does not correspond with local realities on the ground. My thesis provides an in-depth anthropological study of how this occurs within practices in and around World Spine Care's (WSC) clinics in Shoshong and Mahalapye, Botswana. More specifically I explore how knowledge is negotiated and improvised on the ground, paying particular attention to the ways WSC volunteers are (un)able to work with local health workers as they desire. I show the flows and counter-flows implicated in the difficult task of reconciling skills with standards. The study is based on a total of 15 months of participation with WSC's organization through attending meetings, activities and shadowing practitioners both in Ottawa and in Botswana. Expanding the scope of their creative improvisational skills beyond the closed settings of WSC clinics is proposed as a way to move forward.

The thesis is based on three months of participant observation in a long-term care facility in 2010 and interviews conducted during next three years. It draws from a perspectives of medical anthropology and anthropology of institutions. The focus is on an ethnography of institution for clients with chronic mental disease, dementia and substance abuse. The thesis is mapping institution's components and actors, their social life and relationships in the institution. The analyses is based upon the concept of total institution by Erving Goffman, and draws from thoughts of Josef Pieper, Martin Buber, Emanuel Lévinas and Michel Foucault. A long-term facility is an institution, which shares clients and some of problems with classical examples of total institutions, but recent reforms aimed to minimalize features of total institutions. Still it does not seem to be a vital institution and new aspects of social situation of staff and clients are recognized. Among new problems is non-existence of therapy for the inhabitants, their marginalization through poor financial situation in an institution, where lot of services are paid and little continuity to other forms of care of more community and ambulant character. Key words: total institution, long-term facility, psychiatric care, medical anthropology,...

<p>Particle pollution in South Korea has become a matter of significant public concern, culminating in its declaration as a “social disaster” through a government proclamation in 2019. This study shows how the existing interventions to tackle particle pollution in South Korea as a “social disaster” contribute to maintaining the status quo, paradoxically. The study attempts to interpret pollution as entanglements, relations, and processes by addressing the discussions and politics surrounding particle pollution, the interventions to tackle it, and what they presuppose and exclude via multi-sited ethnography.</p> <p>What narratives form the bedrock of the current discourses and politics around particle pollution in South Korea? What kinds of population, knowledge systems, values, and interests are incorporated and excluded around particulate matter in Korea? Drawing upon four months of fieldwork, interviews, and collaborative work with residents, scientists, and activists in South Korea, this thesis offers a new understanding of how citizens’ experiences and knowledge practices have reshaped the concepts of pollution, toxicity, and health. The study indicates that the existing practices and knowledge vis-à-vis pollution control have individualized pollution by presuming particular ways of normalcy and excluding others. In doing so, this study captures the multiplicity of particle pollution and shows the existence and stories of different bodies living with/in pollution.</p> <p>Drawing on the literature in feminist science and technology studies as well as medical and environmental anthropology scholarship, this study problematizes harm reduction-based environmental and health intervention practices by describing the current individualized particle pollution responses. The research reveals how people in Korea living with/in particulate matter have perceived, datafied, defined, adjusted, and responded to particle pollution and its toxicity. The study suggests that pollution should be envisaged as entanglements and relations by shedding light on the stories that particulate matter has been perceived, coordinated, and generated in various ways. Lastly, indicating that the knowledge and interventions surrounding particle pollution have exploited and flattened the environment based on the human–nature dichotomy, the study suggests different ways of conceptualizing pollution, while considering the multiplicity of pollution, toxicities, and bodies.</p>

Direct-to-consumer genomics (DTCG) health testing offers great promise to humanity, however to date adoption has lagged as a result of consumer awareness, understanding, and previous government regulations restricting DTCG companies from providing information on an individual's genetic predispositions. But in 2017 the broader DTCG market which also includes genealogical testing demonstrated exponential growth, implying that DTCG is starting to diffuse as an innovation. To better understand the sociocultural forces affecting diffusion, adoption, and satisfaction, qualitative ethnographic research was conducted with DTCG genealogy and health consumers. The data was qualitatively analyzed using thematic analysis to understand the similarities and differences in beliefs, attitudes, intentions, and mediating factors that have influenced consumers. Design anthropology theory and methods were used to produce ethnographically informed insights. The insights were then translated into actionable product management and business strategy recommendations.

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This study encompasses an anthropological investigation of healing practices in the Zion Christian Church with reference to the Marabastad congregation in Pretoria (Tshwane), South Africa. The Zion Christian Church functions as an extremely successful healing ministry, and can thus be characterised as a spirit-type African Initiated Church, a type known to attract members through healing activities. The concepts of ill-health, health, healing and curing are crucial to understanding the church’s role, as all activities at the Zion Christian Church revolve around the attainment of absolute health. The embedded nature of healing in the church is explored through an analysis of the spatial and material aspects of the church’s healing practices, including codes of conduct, roles of participants, religious services, and intangible and tangible instruments of healing. The study is further contextualised against the broader history of the emergence and growth of African Initiated Churches from the late 19th century onwards / Anthropology & Archaeology / M.A. (Anthropology)

Le mal de ventre chez les enfants est un lieu de métissage et de créolisation traversé par des dimensions sociales et culturelles. Il est construit collectivement au sein des familles nucléaires avec leurs parcours migratoires et leurs souffrances. Par le biais d’entretiens menés auprès de familles haïtiennes vivant à Montréal, nous documentons les trajectoires de ces douleurs, dans lesquelles les perceptions, les explications et les moyens mis en œuvre pour les soulager interagissent d’une manière dynamique. En général, les enfants perçoivent leurs maux de ventre comme une expérience insaisissable, diffuse et ayant un impact sur leur vie sociale, tout en étant tolérés par les enfants et par les mères. Ces familles n’ont pas reçu de diagnostic médical et elles attribuent à ces maux des explications provisoires en constante recomposition. En général, elles ont recours à différentes méthodes de prise en charge des maux de ventre. L’espace familial, les activités réalisées au sein des églises et la médecine officielle sont des espaces thérapeutiques privilégiés. / Belly-stomachaches in children are a space of hybridity and creolization, affected by social and cultural dimensions. These aches are collectively constructed within nuclear families, with their migratory histories and their sufferings. Having interviewed Haitian families living in Montreal, we documented the illness trajectories, the perceptions, explanations and means of relieving the aches, which all interact in a dynamic mode. Generally speaking, the children perceive their belly-stomachaches as an irregular experience that has an impact on their social life, although tolerated by the children and theirs mothers. Families have not received a medical diagnosis and give temporary, changing explanations to the aches, in a constant reformulation. In general, families will use different methods to deal with belly and stomach aches. The family space, church activities, and official medicine are privileged therapeutic spaces.

La présente étude en anthropologie médicale propose d’examiner la dimension socioculturelle des désordres fonctionnels gastro-intestinaux (DFGI) en considérant l’expérience de six familles québécoises francophones où un pré-adolescent souffre de symptômes associés à un DFGI. Le regard anthropologique qui nous a permis d’appréhender ces expériences de douleur s’appuie principalement sur les travaux issus de la psychiatrie transculturelle, de même que sur les influences de l’anthropologie du corps et de la phénoménologie. À travers ce regard, la somatisation est considérée comme une forme de communication de la douleur, modulée de manière importante par le contexte socioculturel et représentative d’une certaine souffrance sociale. Ce langage ponctué d’idiomes de détresse et de métaphores permet aux individus d’exprimer leur souffrance et de mobiliser un soutien social efficace pour la prendre en charge. Dès lors, le corps doit être perçu comme un corps vécu; comme un lieu de marquage du social, mais également comme un instrument de positionnement social et une frontière où des mouvements d’appartenance et de divergence sont exprimés. Par l’exploration, dans chacune de ces familles, des différentes manières de décrire les symptômes, de les interpréter et d’y réagir, nous avons procédé à la reconstruction d’histoires particulières pour voir comment ces symptômes venaient s’inscrire dans la biographie individuelle et familiale. À travers l’analyse de la construction du sens de la douleur et des pratiques adoptées pour la contrôler, la douleur abdominale nous est apparue comme intimement liée à l’expérience sociale et la médicalisation comme une base pour une meilleure appréhension de cette douleur. Par ses maux de ventre, l’enfant exprime ses limites corporelles et sociales. À l’intérieur de la famille, l’expression de cette limite peut être parfois dérangeante, confrontante, et même entraîner des rapports conflictuels. C’est ainsi qu’est « négociée » une approche appropriée à la douleur qui redéfinit les rôles de chacun par rapport à cette dernière. Le ventre devient le médiateur qui permet le compromis nécessaire au « vivre ensemble » ou au « vivre dans le monde ». À l’issue de ii cette négociation qui implique la participation du médecin traitant, les rapports sont parfois reconstruits et la relation au monde et aux autres peut devenir différente. / This study in medical anthropology is an exploration of the sociocultural dimension of functional gastrointestinal disorders (FGID) considering the experience of six frenchspeaking families of Québec where a pre-teenager suffers from symptoms associated with FGID. The anthropological perspective that allowed us to approach these experiences of pain is based mainly on work from tanscultural psychiatry, as well as on the influences of the anthropology of the body and phenomenology. Through this view, somatization is considered to be a form of communication of distress, modulated in an important way by sociocultural context and reflecting social suffering. This language punctuated with idioms of distress and metaphors allows individuals to express their suffering and to mobilize an efficient social support. From then on, the body must be seen as a lived body; as a place of social marking, but also as an instrument of social positioning and a border where movements of belonging and divergence are expressed. By exploring, in each of these families, different ways of describing the symptoms, interpret them and respond to them, we proceeded to the reconstruction of particular stories to find how these symptoms were part of the individual’s and family’s biography. Through the analysis of how those families make sense of the pain and adopte practices to control it, abdominal pain appeared to us as intimately linked to social experience and the medicalization as a basis for a better apprehension of this suffering. While telling his or her pain, the child is also expressing his or her bodily and social boundaries. Within the family, the expression of this limit can sometimes be disturbing, confrontational, even lead to conflict. Thus was “negociated” an appropriate approach to pain that redefines the roles of each in relation to it. The abdomen becomes the mediator who allows the compromises needed to “live together” or to “live in the world”. Following this “negociation” that involves the participation of the attending physician, bonding within the family is sometimes positively transformed and the relation to the world and to the others can become different.