Identity,community and care in online accounts of hereditary colorectal cancer syndrome

Sociological literature has explored how shifts in the point at which individuals may be designated as diseased impact upon experiences of ill health. Research has shown that experiences of being genetically “at risk” are shaped by and shape familial relations, coping strategies, and new forms of biosociality. Less is known about how living with genetic risk is negotiated in the everyday and over time, and the wider forms of identity, communities and care this involves. This article explores these arrangements drawing on online bloggers’ accounts of Familial Adenomatous Polyposis (FAP). We show how accounts of genetic risk co-exist with more palpable experiences of FAP in everyday life, notably the consequences of prophylactic surgeries. We consider how the act of blogging represents but also constitutes everyday experiences of hereditary cancer syndrome as simultaneously ordinary and exceptional, and reflect on the implications of our analysis for understanding experiences of genetic cancer risk.     

Living the multicultural city: acceptance,belonging and young identities in the city of Leicester,England

Drawing upon research conducted with young people in the city of Leicester, England, this paper explores what it means for those from black and minority ethnic communities, particularly more recent arrivals, to live within and adapt to specific multicultural urban contexts. After introducing prevailing racisms and accommodations, the paper examines how forms of belonging are expressed, re-produced and negotiated through the spatial trajectories of everyday life. This includes the value of emerging versions of place through community, religious practice as a form of social capital, the importance of routine, and the construction of multifaceted identities. Such experiences relate to contingent hierarchies of acceptance and legitimacy, histories of settlement, economic marginalization, as well as gendered and generational roles. These young people negotiate everyday life and belonging by retaining, extending and forging local and trans-national ties; highlighting the relationship between socio-spatial positions, everyday practice and identity formation.     

The cosmopolitics of flow and healing in north‐central Timor‐Leste

In north central Timor‐Leste, multi‐sensory ecological engagement is deeply entangled with conceptualisations of and approaches to people’s wellbeing. How people understand human health and wellbeing is closely related to how they understand nature or more particularly human/nature relations and distinctions across multiple timescales. Working through complex cosmopolitics and activated through cross‐temporal more‐than‐human ‘mutualities of being’, kinship networks are attuned to relational flows between ‘bodies’ and things. Rather than concentrating on the disjunctions created by the differences in the natures of beings or their ritual separation, this paper examines how relational flows between such ‘bodies’ and things open up cosmopolitical spaces for the creation and negotiation of intergenerational wellbeing.     

“Nothing Special,Everything Is Maamuli”: Socio-Cultural and Family Practices Influencing the Perinatal Period in Urban India

Background

Globally, India contributes the largest share in sheer numbers to the burden of maternal and infant under-nutrition, morbidity and mortality. A major gap in our knowledge is how socio-cultural practices and beliefs influence the perinatal period and thus perinatal outcomes, particularly in the rapidly growing urban setting.

Methods and Findings

Using data from a qualitative study in urban south India, including in-depth interviews with 36 women who had recently been through childbirth as well as observations of family life and clinic encounters, we explored the territory of familial, cultural and traditional practices and beliefs influencing women and their families through pregnancy, childbirth and infancy. We found that while there were some similarities in cultural practices to those described before in studies from low resource village settings, there are changing practices and ideas. Fertility concerns dominate women’s experience of married life; notions of gender preference and ideal family size are changing rapidly in response to the urban context; however inter-generational family pressures are still considerable. While a rich repertoire of cultural practices persists throughout the perinatal continuum, their existence is normalised and even underplayed. In terms of diet and nutrition, traditional messages including notions of ‘hot’ and ‘cold’ foods, are stronger than health messages; however breastfeeding is the cultural norm and the practice of delayed breastfeeding appears to be disappearing in this urban setting. Marriage, pregnancy and childbirth are so much part of the norm for women, that there is little expectation of individual choice in any of these major life events.

Conclusions

A greater understanding is needed of the dynamic factors shaping the perinatal period in urban India, including an acknowledgment of the health promoting as well as potentially harmful cultural practices and the critical role of the family. This will help plan culturally appropriate integrated perinatal health care.     

Learning the Moral Economy of Commodified Health Care: “Community Education,” Failed Consumers,and the Shaping of Ethical Clinician-Citizens

Leaders of health professional schools often support community-based education as a means of promoting emerging practitioners’ awareness of health disparities and commitment to serving the poor. Yet, most programs do not teach about the causes of health disparities, raising questions regarding what social and political lessons students learn from these experiences. This article examines the ways in which community-based clinical education programs help shape the subjectivities of new dentists as ethical clinician-citizens within the US commodified health care system. Drawing on ethnographic research during volunteer and required community-based programs and interviews with participants, I demonstrate three implicit logics that students learned: (1) dialectical ideologies of volunteer entitlement and recipient debt; (2) forms of justification for the often inferior care provided to “failed” consumers (patients with Medicaid or uninsured); and (3) specific forms of obligations characterizing the ethical clinician-citizen. I explore the ways these messages reflected the structured relations of both student encounters and the overarching health care system, and examine the strategies faculty supervisors undertook to challenge these messages and relations. Finally, I argue that promoting commitments to social justice in health care should not rely on cultivating altruism, but should instead be pursued through educating new practitioners about the lives of poor people, the causal relationships between poverty and poor health, and attention to the structure of health care and provider–patient interactions. This approach involves shining a critical light on America’s commodified health care system as an arena based in relations of power and inequality.     

Spirits out of place: relational landscapes and environmental change in East Kalimantan,Indonesia

This article examines interaction with spirits among the Luangan, a group of shifting cultivators in Indonesian Borneo. Through examples of different forms of Luangan spirit interaction, it interrogates the relationship between the spirit world and the natural environment, with special reference to what happens when the latter undergoes dramatic change. Inspired by Eduardo Kohn's understanding of how the spirit world is semiotically embedded within the rainforest environment, I explore how relations with nonhumans reflect historical and ongoing experiences of life and sociality in the forest and human domain, while superimposing a virtual relational landscape upon the natural landscape. It is proposed that spirit communication offers a means of refiguring human lives and alleviating debilitation, and that recurrent rituals enable Luangans to virtually maintain relations with unseen beings of the local environment, even where it has been thoroughly transformed through oil palm cultivation.     

Super-diverse street: a ‘trans-ethnography’ across migrant localities

This paper emerges from an ethnography of the economic and cultural life of Rye Lane, an intensely multi-ethnic street in Peckham, South London. The effects of accelerated migration into London are explored through the reshaping and diversification of its interior, street and city spaces. A ‘trans-ethnography’ is pursued across the compendium of micro-, meso- and macro-urban spaces, without reifying one above the other. The ethnographic stretch across intimate, collective and symbolic city spaces serves to connect how the restrictions and circuits of urban migration have different impacts and expressions in these distinctive but interrelated urban localities. The paper argues for a trans-ethnography that engages within and across a compendium of urban localities, to understand how accelerated migration and urban ‘super-diversity’ transform the contemporary global city.     

Can Schools Support HIV/AIDS-Affected Children? Exploring the ‘Ethic of Care’ amongst Rural Zimbabwean Teachers

How realistic is the international policy emphasis on schools ‘substituting for families’ of HIV/AIDS-affected children? We explore the ethic of care in Zimbabwean schools to highlight the poor fit between the western caring schools literature and daily realities of schools in different material and cultural contexts. Interviews and focus groups were conducted with 44 teachers and 55 community members, analysed in light of a companion study of HIV/AIDS-affected pupils’ own accounts of their care-related experiences. We conceptualise schools as spaces of engagement between groups with diverse needs and interests (teachers, pupils and surrounding community members), with attention to the pathways through which extreme adversity impacts on those institutional contexts and social identifications central to giving and receiving care. Whilst teachers were aware of how they might support children, they seldom put these ideas into action. Multiple factors undermined caring teacher-pupil relationships in wider contexts of poverty and political uncertainty: loss of morale from low salaries and falling professional status; the inability of teachers to solve HIV/AIDS-related problems in their own lives; the role of stigma in deterring HIV/AIDS-affected children from disclosing their situations to teachers; authoritarian teacher-learner relations and harsh punishments fuelling pupil fear of teachers; and lack of trust in the wider community. These factors undermined: teacher confidence in their skills and capacity to support affected pupils and motivation to help children with complex problems; solidarity and common purpose amongst teachers, and between teachers and affected children; and effective bridging alliances between schools and their surrounding communities–all hallmarks of HIV-competent communities. We caution against ambitious policy expansions of teachers'' roles without recognition of the personal and social costs of emotional labour, and the need for significant increases in resources and institutional recognition to enable teachers to adopt support roles. We highlight the need for research into how best to create opportunities for teacher recognition in deprived and disorganised institutional settings, and the development of more culturally appropriate notions of caring.     

Rights and responsibilities in rural South Africa: implications for gender,generation, and personhood

In the rural Eastern Cape, South Africa, contests over the meaning and merit of human rights feature prominently in intergenerational and intergendered conflicts. In this article I identify and analyse a tension between amalungelo (a socially embedded and relational form of rights) and irhayti (a Xhosaization of the English ‘[human] right’) as a means of exploring the interpersonal tensions that arise through the production and contestation of the subject positions that human rights set in motion. Using the examples of elders’ complaints of neglect, and of young men's accusations of human rights violations on the part of women, I ground this investigation in men's and elders’ explanations of how human rights enable morally reprehensible actions, and are implicated in what they perceive to be a climate of interpersonal neglect. In analysing these claims, I show that gendered and generational conflict in this region is grounded in uncertainty about the content of gendered and generational subject positions themselves, and speaks to the relative moral value of autonomous versus relational forms of personhood. Moreover, I show that where inequality and interdependence are intrinsic to the ways in which gendered and generational subject positions are constituted and understood, human rights serve both to destabilize the content of these subject positions in ways that render appropriate gendered and generational sociality unclear, and also to bring into question the relative moral value of autonomous versus more relational forms of personhood.     

Caring claims and the relational self across time: grandmothers overcoming reproductive crises in rural China

Revisiting the notion of relational personhood from a Chinese perspective, this article explores the premises of exchange underlying discourses of care, reproduction, and kinship in anthropology. Grandmothers contribute much of the care needed for reproduction of the next generation of children in the Chinese countryside. Their motivation to contribute care to secure offspring stems from the frustration of their past familial desires, and their hopes for transcendence through reproduction in the future. Grandmothers secure claims to offspring through their care between the interstices of the state bureaucracy and patrilineal norms. This care is not simply nurturing but can also become coercive and competitive. As Chinese grandmothers overcome past reproductive hardships by claiming future offspring through care, their selfhood not only becomes distributed through exchange with others, but also is dispersed across time in relation to past experiences and future aspirations of the self.     

Towards Sustainable Cities. Urban Community and Environment in the Third World

The role of the city in environmental change and deterioration seems to be ambivalent and in order to explore this ambivalence we have to pose several questions. What is the essence of the city in generating development, on the one hand, and of environmental problems, on the other hand? How have the relations between town and countryside been shaped and how are these relationships connected to sustainability of town and countryside? What exactly do we mean by sustainability? What are the factual environmental problems of Third World urban and metropolitan areas, and what are the practical solutions implemented inthese areas? We do not pretend to be able to solve the pressing social issues implied in these questions, but merely hope to supply some thoughts to give food for further reflection.     

Biomedicine on the Spatial Periphery: The (Re)Production of a Metaphorical Landscape by Rural Health Care Practitioners in Northern California

I examine the use of spatial concepts by rural health care practitioners in Northern California and suggest that rural and urban spatial metaphors are important means of expressing and (re)producing problems associated with their search for legitimacy and moral authority within a field of relations defined by biomedicine. I present three broad ways in which spatial metaphors are used by rural health care practitioners to continuously enact a "metaphorical landscape." I situate this landscape in the context of a hierarchical field of relations within biomedicine, which is itself underpinned by a distinct urban bias and the uneven distribution of material and technological resources. I suggest that this landscape is partly the result of the rural health care practitioners' position within this field of relations and partly the result of implicit and historically situated frameworks of spatial meanings derived from capitalism.     

The urban heat island in a small city in coastal Portugal

This project arose from the need to study the phenomenon of the urban heat island, since only by recognising this phenomenon can we moderate it to improve the human and urban environments. Not only big cities develop urban heat islands. This study detected the presence and recorded the characteristics of an urban heat island in the small coastal city of Aveiro, Portugal. The study was developed through the scheduled measurements of air temperature and the analysis of the geographical, meteorological and urban conditions. The form and intensity of Aveiro’s heat island are a response to the interaction of three principal factors: the urban morphology (the hottest zones in the city are those with the tallest and the highest density of buildings, without green spaces and with intense generation of heat from traffic, commerce and services); the meteorological conditions (the intensity of the island is at its maximum when the sky is totally clear and there is no wind, and at its minimum in those situations when there is atmospheric instability, such as wind, cloud and precipitation); and the proximity of the coastal lagoon (which borders the city to the west and northwest and moderates seasonal temperatures. The urban heat island influences the comfort and health of its inhabitants, thus urban planning is very important in the moderation and prevention of this phenomenon. Received: 7 July 1999 / Revised: 24 April 2000 / Accepted: 26 April 2000     

Doing the City from the Margins: Critical Perspectives on Urban Marginality*

ABSTRACT

This special issue focuses on urban marginality in diverse contexts across the world (Africa, Latin America, Arab States and Europe) and proposes anthropological perspectives on contemporary urbanity that take into account the complexity of the social positions of those city dwellers that are on the margins. Three aspects of urban margins come to the fore. First, urbanites respond to increasing marginalisation through the production of alternative meanings and narratives about the city. While grand, powerful narratives may present cities as ‘divided’, ‘dual’ or ‘conflicted’, urban dwellers may carve out symbolic space through discourses of the non-spectacular and non-political, emerging out of lived space. Second, the cuts and frictions constituting urban margins do not only limit urban dwellers capacities, but can also provide spaces of agentic possibilities. As it is well known, the absence of state control can be turned by versatile urbanites into opportunities of the ‘informal’ economy. Third, urban dwellers engage in manifold practices that connect and entangle their marginalised position with spaces of power and resources. Through their practices urban margins become a relation to, not a disconnection from the ‘centre’. In this special issue we understand ‘urban margins’ not as essence or entities, but as forms of relations between urban dwellers shaped by processes of political, economic, spatial and social marginalisation. Seen in this way, urban margins constitute a perspective on the urban: a lens to entice comparisons of urban agency in the world of cities [Robinson, J. 2011. “Cities in a World of Cities: The Comparative Gesture.” International Journal of Urban and Regional Research 35 (1): 1–23. doi:10.1111/j.1468-2427.2010.00982.x]].     

对城市大型医院优质医疗资源下沉若干问题的思考

改革县级公立医院的运行机制,提升县级公立医院服务能力,发挥县级公立医院的区域基本医疗中心的作用,是体现公立医疗机构的公益性,解决基层群众就医需要的关键措施。文章结合我国医疗资源配置的区域失衡,通过对浙江省城市大型医院与县级公立医院通过托管等不同形式建立协作关系的情况和效果进行了总结,对城市大型医院优质医疗资源下沉到县区开展医疗服务的活动进行了评价和分析,并且进一步阐述了从根本上改变区域医疗资源失衡、完善医疗服务体系、促进医疗卫生事业健康发展的策略。     

Life on the hoof: gender,youth, and the environment in the Indian Himalayas

This article examines how young people in the Indian Himalayas understand, appreciate, and discuss their environment. Building on intensive ethnographic field research in Bemni, Uttarakhand, I point to the changing ways in which young people use the everyday practice of herding to acquire knowledge and engage in playful activity. I emphasize that age and gender shape the capacity for young people to interact creatively with their local environments. I will argue that studies of human/environment relations might usefully combine a focus on the movement of individuals through environments with a focus on the gendered ways in which they move through the life‐course.     

Ebola separations: trust,crisis, and ‘social distancing’ in West Africa

The Ebola outbreak in West Africa involved the introduction of new forms of social and physical separation that aimed to curtail the spread of the disease. People changed the ways they lived to avoid contact with those who might be sick. A suite of governmental instruments was introduced, ranging from by-laws and public health campaigns to the use of specialist treatment centres and military force. These events transformed social connections and affected possibilities for trust in intimate, governmental, and therapeutic relations. Drawing upon fieldwork in Sierra Leone, Liberia, and Guinea, this article explores these forms of separation and social distance ethnographically, with a focus on material objects, touch, and spaces of separation. In doing so, we contribute to discussions on the constitution of trust and distance within social relations, and the ways in which separation can enable certain kinds of closeness. Our analysis offers insights for those seeking to understand the impact of the ongoing COVID-19 pandemic on the ways that people relate to, and care for, others.     

Gender and the dynamics of mobility: reflections on African migrant mothers and ‘transit migration’ in Morocco

By describing the everyday lives of African migrant mothers and their children in Morocco, this paper highlights how migration and ‘immobility’ in so-called ‘transit countries’ are gendering and gendered experiences. Relying on migrants' narratives, the paper demonstrates how migrants' transitions to motherhood create both specific and gendered spaces for agency and particular and gendered constraints upon agency that shape women migrants' mobility dynamics in space and time.     

奥本罗历史城区中心——从远期总体规划到公共空间更新

ADEPT建筑事务所与Topotek1事务所最近在丹麦的集镇—奥本罗完成了一个历史城区的改造。在基于当地现状条件完成的公共空间再设计与城市总体规划之间创造了紧密的联系,通过趣味性的设计手法以及对传统材料的创新使用,使历史悠久的城区中心为公共空间的更新做好了准备。此项目的改造基于历史城区中心的特征、规模及过往经历完成,同时也为街道和广场增添了现代感。为满足城市中各类型公共生活而设计的铺装和城市家具强调了这一新特征。在创造从宏观到细节之间明确关联性的过程中,目标是建立一个具有整体性的历史城区中心的鲜明特点,同时也通过局部细节的处理使不同的公共空间各具特色。     

Chikotsa--secrets, silence, and hiding: social risk and reproductive vulnerability in central Mozambique

In this article, I examine pregnancy narratives and patterns of reproductive health seeking among women of fertile age in central Mozambique. I map the interplay between gendered economic marginalization, maternal risk perceptions, and pregnancy management strategies. By interpreting my data in light of Shona illness theories, I illuminate the ways that embodied experiences of reproductive vulnerability, risk perceptions, and social inequalities are linked: women attribute the most serious maternal complications to human- or spirit-induced reproductive threats of witchcraft and sorcery. This construction of reproductive vulnerability as social threats related to material and social competition significantly influences prenatal health seeking. Data reveal the structural and cognitive gap between biomedical constructions of risk and lay social threat perceptions. Plural health care systems are strategically utilized by women seeking to minimize both social and biological harm. On-the-ground ethnography shows that maternal health initiatives must take this plurality into full and accommodative account to achieve viable improvements in reproductive care and outcomes.