Afterword: In Search of Melanesian Order

ABSTRACT

These essays explore three contemporary forms of order in Papua New Guinea: improvised village courts, a nursing school curriculum including village practicums, and student boycotts and strikes. My comments assess these new sorts of order as reflected against earlier ethnographic accounts of Papua New Guinean societies as well as those elsewhere in Melanesia. This often has taken the region’s social groups and lineages, religions and belief systems, and most recently the Melanesian state itself to be weak, messy, and inconstant. I ask how culturally ‘Melanesian’ are these contemporary examples of order and disorder, and find significant continuities in their underlying nostalgia for an imagined, more orderly past, in beliefs about causes of disorder, and in strategies and remedies to order and reorder everyday life.     

Tradisi and Moderen,Village and State: Emergent Tensions in a Sasak Health Quest

On Lombok island, in the province of West Nusa Tenggara, Indonesia, indigenous medicine and biomedicine coexist. Nevertheless, biomedicine, a product of modernity and the development of the state has been superimposed on village life along with other state institutions such as education. In this paper I analyse the processes involved in Sasak villagers' quest for health. Operating within various and sometimes overlapping social fields and conflicting discourses, villagers utilise both local indigenous practices as well as the Indonesian national health system in their quest. Because local or ordinary knowledge is a rich resource for interpretation, I describe the health quest through the participant individuals: family members, neighbours, doctors and nursing personnel involved. The subjectivity of the individual participants contributes to the intricate unfolding of health seeking quests to expose the various tensions which emerge between tradition (tradisi [I]) and modernity (moderen [I]) and between state and village.     

Water Justice and Integrated Water Resources Management: Constitutionality Processes Favoring Sustainable Water Governance in Mexico

This research analyzes four ongoing water conflicts in Jalisco state, Mexico, through the lens of constitutionality. Constitutionality refers to a bottom-up institution building process based on the activation of emic perceptions of people who are often marginalized in policymaking, as well as on alliances with external actors, with the aim of achieving recognition by the state of self-created institutions. Results show that the constitutionality concept helps to link analysis of local people’s resistance movements against top-down water policies with an emerging process of institutional innovation that aims for more sustainable water governance. Local institutional innovations embody the principles of water justice; these are recognized by the state as being part of its own Integrated Water Resources Management (IWRM) policy, and thus find their way into state policy arenas. This analysis provided the basis for the formulation of a conceptual framework that integrates water conflicts, water justice, and IWRM into the concept of constitutionality.     

县乡村三级卫生人力资源的构成与分布特征研究

目的 通过分析县乡村三级人力资源配置的内部构成及各级机构间的分布差异情况,为农村卫生人力资源的纵向整合和三级医疗预防保健网的建设提供依据。 方法 用EXCEL2010分析各级医疗机构的人口学特征及内部构成比,用SPSS20.0进行卡方检验分析不同级别,不同地域类型的医疗机构卫生人员的构成与分布是否存在差异。结果 总体上男性医务人员多于女性医务人员,但由于村卫生室以乡村医生为主,所以医务人员的内部构成比例和性别分布情况与县乡两级机构不同。60岁及以上人员在县级医疗机构为2.69%,在村卫生室的比例达27.51%（P<0.05）。与2014年相比,2015年该市乡镇卫生院人员引进了15人,流失了27人,而县级医院引进了50人,流失了24人。结论 分级诊疗相关政策影响农村卫生人力资源的配置和床日负担水平,县乡村三级医疗机构医务人员的性别年龄分布均有差异,不同地域类型乡镇卫生院均需对高学历医务工作者给予针对性的激励措施。     

KINSHIP MATTERS: WOMEN's LAND CLAIMS IN THE SANTAL PARGANAS, JHARKHAND

This article discusses the strengthening of kinship ties amongst the Santal community in a village in Jharkhand state in India. The context of progressive marginalization from the state and markets has resulted in the Santals asserting their adivasi identity by recourse to customary institutions as well as rigidifying patrilineal rules of inheritance. While this leads generally to an erosion of women's rights to inherit land, under certain circumstances women are supported by kin elders when they bring grievances to the legal courts. Women's relationship to their kinship group thus seems ambiguous: kinship can simultaneously be not only a source of deprivation and suppression but also a way of staking claims to resources, especially in the face of the inadequacies of formal state mechanisms.     

On "Indian Justice"

Abstract

In 1908 a Mescalero Apache who had killed a white man was tracked down and killed by an all-Mescalero posse. The crime of the fugitive and the behavior of his pursuers do not reflect some crossculturally inexplicable, specificaliy “Indian justice”, as various published comments have suggested. The Indian justice involved has to do with the precautions taken by the Indian leaders to discourage the development of an intra-community feud on the basis of the execution.     

Hybridisation in a Case of Diamond Theft in Rural Sierra Leone

ABSTRACT

Drawing on cultural studies, the concept of hybridity has emerged in peace and conflict studies as an important critique of the fragile failed/state discourse, and the binaries whereby the modern state is often contrasted with traditional or non-state actors. The concept is also challenged for reproducing the very binaries that it seeks to overcome and lacking analytical vigour. The paper addresses these critiques by exploring a case of diamond theft in rural Sierra Leone. It suggests an analytical shift from interaction between state institutions (police) and non-state authorities (traditional leaders) to focusing on processes of hybridisation through the enactment and performativity of authority. This is an analytical move from preconceived cultural and political entities to the subject and the simultaneous quality of how he or she assembles and projects authority. It is in the subject’s strategies and practices at the micro level that we clearly see how hybridisation processes occur.     

Custom In The Courtroom, Law In The Village: Legal Transformations In Papua New Guinea

After more than twenty-five years on the legal landscape of Papua New Guinea, 'customary law' is ripe for reassessment, particularly as it appears to be an ideal mechanism with which the Papua New Guinean state can meet some of its obligations to a burgeoning body of international law. This article addresses the need to understand customary law in the context of its varying usage across different legal domains in an archetypally pluralistic state. In contrast to older approaches focusing on the problematic interface between an exogenous legal system and indigenous methods of dispute settlement, my concern is with the ways in which these distinct legal forms have fared in each other's company since independence in 1975. Case-studies from a village court and an urban national court demonstrate that village court magistrates and high court judges alike use custom and law as strategic sources of authority. While village courts take custom for granted and therefore must 'discover' law, high courts take law for granted and must 'discover' custom. These processes indicate that, rather than being hybridized as 'customary law', the distinctiveness of custom and law are often maintained in order for one to appear as a resource upon which the other can draw.     

Contesting Patrimony: Cusco's Mystical Tourist Industry and the Politics of Incanismo

The Peruvian state's neoliberal policies include its mission to modernize Peru through international tourism and foreign investment, and tourism promoters and politicians increasingly invoke Andean mysticism and Inca patrimony (or incanismo) as a marketing strategy. This paper argues that Cusqueño citizens invoke the same representations, with competing claims of authenticity and authority, as they construct their own versions of Incanist identification in populist movements against the state and its enforcement of the global neoliberal order, as well as in their attempts to survive in the tourist economy. In Peru, criticism of the tourist industry is often grounded in incanismo and seems to take aim at the neoliberal order. However, closer analysis reveals a more complicated set of relationships between resistance and liberalism. Friction emerges not because cultural identity is being commodified or inequalities persist, but because local desires for access to the market are frustrated by state and municipal agencies.     

Power/Knowledge,Power/Ignorance: Forest Fires and the State in Mexico

For over a century the Mexican state has justified its control of forests by claiming that rural people are ignorant and destructive fire setters, in the face of abundant evidence to the contrary. Academic and popular stereotypes of the state have tended to assume that official power and knowledge go hand in hand. In an institutional ethnography ofthe Mexican environment agency, SEMARNAP, I. show how official ignorance is deployed both within and outside state forestry institutions, and how ignorance and complicity may be as important as knowledge in asserting state power. Rather than internalizing official fire discourse, rural people in Mexico learn to mouth polite fictions in their encounters with officials. I argue that the scholarship on governmentality derived from Foucault has uncritically internalized the link between power and knowledge. A closer attention to the production and translation of knowledge within state institutions leads to a more nuancedunderstanding of various forms of obscurity and ignorance which accompany official knowledge claims. This paper is drawn from my fieldwork and archival research in Mexico in the summer of 1998 and between April 2000 and August 2001.     

Women and the Iranian Revolution: A village case study

Conclusion All in all, the activism of the Aliabad seyyid women in the Iranian Revolution followed the lines of traditional concerns, traditional methods, and traditional constraints on the activities of women. Women hoped for improved justice, safety for their families, and restoration of a semblance of peace in the village and the nation as a whole. Women's political methods were those of social interaction and use of their verbal abilities, emotional displays, and physical presence to show support. They followed the usual constraints on their behavior by marching in the company of their usual network of companions, separate from men and covered with their chadors, and did not neglect their families and households.The two changes were in the level of political involvement: national rather than local level, and the locus of political activity—Shiraz rather than the village of Aliabad. The local level of political activity was no longer the level at which policy and forces determined the safety and welfare of their family and relatives. With the Shah's centralization program, power over the lives of villagers lay at higher levels. With the merging of local level politics and national level politics during the incidents of violence on December 7 and 8, 1978, women began to realize that the target of their political activism must also be at higher levels. In hopes of having some effect on national level politics and thereby on the safety and welfare of their family members, the Aliabad seyyid women traveled into Shiraz to demonstrate in the revolutionary movement

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Factors related to traditionalism among Navajo students

Strong communal identities and institutions have survived in the Mexican state of Oaxaca in spite of over 150 years of central state efforts to eliminate them. This article examines why this is so, focusing on the liberal reform period of 1856 to 1911, when state officials mandated the privatization of communal land held under corporate title by Mexico's indigenous communities. In contrast to much of the literature on nations and nationalism, in which local and national identities are held to be in opposition, the article argues that local identities and institutions survived in Oaxaca precisely because villagers employed national identities, discourses, and institutions in their defence. More generally, the article contends that we need to rethink the conventional contrast between local and national identities, in order to better comprehend the politics of nation-building and state formation: local identities (communal, ethnic, regional, religious) can only be understood in terms of how they relate and respond to national identities and state institutions; national identities and state institutions, in turn, are in part constructed by subordinate groups whose understanding of the nation is informed by their own local identities, cultures and histories of political conflict.     

可分流康复机构的住院病人筛选方法与实证研究

目的 在我国积极推进分级诊疗的背景下,研制可准确测算大型医院内可分流至康复机构的的住院病人数量的方法。方法 基于华东某大型城市当地居民的就医基础数据进行方法学实证模拟,构建大型医院可分流至康复机构的住院病人数据库。结果 华东某大型城市可下沉至康复机构的人数为5.6万人次,总下沉床日数为55.4万床日,可节省费用11.7亿。结论 测算方法与结果受专家认可,可为当地政府合理利用床位资源、明确分级诊疗潜力和评价分级诊疗政策的实施效果提供科学性的支撑和参考。     

我国医药分开政策目的及其策略分析

目的 进一步明确医药分开政策目的及策略。方法 采用文献回顾性研究法,对医药利益链条及其形成原因,以及解决策略进行系统性地总结和分析。结果 现有研究一是认为医疗服务提供方拥有垄断地位造成利益链条存在,因而提出消除垄断;二是认为扭曲的“白色”或不良的“灰色”激励机制造成利益链条存在,因而提出完善“白色”或消除“灰色”激励机制的综合策略。结论 医药利益链条产生更深层次的原因是,非营利性的公立医疗机构不合理地追求经济利益,医生采用不合理方式追求部分合理经济利益。因此,医药分开目的应是让公立医疗机构真正成为非营利机构,使医生依靠技术获得合理的经济回报,让公立医疗机构、医生、政府、患者、药品企业及流通商间激励相容。建议采用外部补偿和内部薪酬制度为重点的综合改革策略,形成各利益相关方激励相容的良好局面,自然消除公立医疗机构、医生与药品销售间利益链条。     

Keeping the faith: African American faith leaders' perspectives and recommendations for reducing racial disparities in HIV/AIDS infection

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders' recommendations for tailoring HIV prevention for a faith-based audience.     

Cultural Competency and Rural Disorder in PNG Health Promotion

ABSTRACT

Health workers in Papua New Guinea strongly emphasise their duty to provide services to the country’s rural majority. Trained to see rural communities as lacking modern discipline and order, they worry that rural people will resist, perhaps with violence, if health workers fail to ‘show respect for culture’. Examining cultural improvisation among nursing students on a rural experience practicum in the Eastern Highlands, I show how students and teachers tried to craft culturally respectful health education. However, when difficulties emerged, local people were described as unable or unwilling to harim tok (understand, heed or follow instructions). The capacity to follow instructions, cultivated through education and Christian faith, was cast as incompatible with Highlands culture. Rural health promotion activities, when they fail to foment major transformation, can help reproduce the ideological construction of the people of the hauslain (village, hamlet) as emotionally volatile and ungovernable.     

Reconciliation and Revenge in Post-Apartheid South Africa. Rethinking Legal Pluralism and Human Rights

Human rights are a central element in the new governmental project in the new South Africa, and this article traces some of the specific forms of connection and disconnection between notions of justice found in townships of the Vaal and rights discourses as articulated by the Truth and Reconciliation Commission. The introduction of human rights in post-apartheid South Africa has had varied social effects. Religious values and human rights discourse have converged on the notion of reconciliation on the basis of shared value orientations and institutional structures. There are clear divergences, however, between human rights ideas and the notions of justice expressed in local lekgotla, or township courts, which emphasize punishment and retribution. The article concludes that the plurality of legal orders in South Africa results not from systemic relations between law and society but from multiple forms of social action seeking to alter the direction of social change in the area of justice within the context of the nation-building project of the post-apartheid state.     

基于绩效的公立医疗机构政府补偿机制的探索

目的 剖析闵行区公立医疗机构政府补偿机制的要素与特点,为深化公立医疗机构改革提供决策参考。方法 收集和梳理政策文件,分析改革前后,政府补偿范围、补偿方式和补偿水平的变化,总结补偿机制特点。结果 改革后医疗服务和公共卫生服务经费按绩效考核结果进行补偿,基本建设和设备购置经费、政府指令性任务、学科发展、人员培养和科研教育经费的补偿标准和办法得到了明确。结论 闵行区公立医疗机构政府补偿机制以公益性为目标,以绩效考核为依据,运用了信息化工具,考虑了机构类型的差异,有利于引导医疗机构持续改进绩效,实现公益性目标。     

“单独两孩”政策对上海市医疗卫生行业的影响研究

目的 了解单独两孩政策的出台对上海市医疗卫生行业的影响,并由此提出有关对策建议。方法 通过宏观层面分析、焦点组访谈、问卷调研等多形式的调查手段,综合分析评估单独两孩政策实施后对上海市医疗卫生系统的需求和影响。结果 单独两孩政策实施对上海市医疗卫生行业的分别产生了三大影响和挑战：（1）影响：未来几年上海市将增加至少10%的年分娩量,2016年可能面临一个生育小波峰; 妊娠风险增加,高风险、高技术含量的产科任务增加;儿科医疗服务量的增加将逐渐出现,呈叠加之势。（2）挑战：政策调整将加剧产科医疗资源使用的不均衡,首要受到冲击的是优质产科机构;妊娠风险增加将进一步考验上海高危产科的整体应对能力;出生人口的增加和不断叠加将使本已短缺的儿科医疗资源雪上加霜。结论 单独两孩政策的影响辐射结果提示了政府主导辅以市场机制调控的重要性和迫切性;需要尽快扭转孕妇自由选择分娩医院的无序状态,保证优质产科资源真正为高危孕产妇服务;整合区域内不同层次产儿科医疗资源,以提高对高危产科的整体应对水平。     

An Assessment of Diversity,Inclusion, and Health Equity Training in Endocrinology Fellowship Programs in the United States

ContextThe Accreditation Council for Graduate Medical Education has instituted common program requirements related to diversity, equity, and inclusion (DEI) for postgraduate trainees in the United States; however, the extent to which DEI training is being incorporated across endocrinology fellowship programs is unknown.ObjectivesTo describe the sociodemographic representation and DEI training experiences within endocrinology fellowship programs.Design, setting, and participantsNational cross-sectional survey study of fellows and fellowship program leaders in the United States whose fellowships were members of the Association of Program Directors in Endocrinology and Metabolism.Main outcome measures(1) Demographics of fellows and program leaders and (2) programs’ experience, confidence, and interest in formal DEI training.ResultsA total of 108 and 106 fellow and faculty responded to the survey, respectively. The majority of fellows and faculty are female. Less than 3% of fellows and 3.7% of faculty identify as Black. More than 90% of fellows/faculty are heterosexual and no respondents identified as transgender/nonbinary; however, 5% and 2% of all respondents preferred not to disclose their sexual orientation and gender identity, respectively. While 85% of faculty received institutional diversity and inclusion training, 67.6% of fellows did. Fellows are more likely to have received training in health equity than program leaders. Both fellows and program leaders express a high interest in health equity curriculum.ConclusionsWithin the diversity of endocrinology training programs, Black physicians are underrepresented in medicine, which persists in endocrinology fellowships. Fellowship programs express enthusiasm for national diversity and health equity curricula, with the majority of programs reporting institutional DEI training.