Category: Article

The People’s Health Assembly

By Zafrullah Chowdhury

In 1978, 134 health ministers from around the world signed the Alma Ata declaration that set a deadline for the year 2000 for achieving a level of health that would enable all of the world’s people to “lead a socially and econmically productive life.” The strategy to achieve the goal would be the implementation of primary health care, with its emphasis on community participation, and tackling the underlying causes of diseases, such as poverty, illiteracy, and poor sanitation. This week, at Gonoshasthya Kendra People’s Health Centre (whose pioneering work formed a case study for the Alma Ata declaration), a People’s Health Assembly will convene to discuss the failure to achieve “Health for All,” and plan what to do next.

Read the article here.

Towards decolonising higher education: a case study from a UK university

By Nancy Tamimi, Hala Khalawi, Mariama A. Jallow, Omar Gabriel Torres Valencia and Emediong Jumbo

This article presents initiatives undertaken by the Department of Global Health and Social Medicine (GHSM) at King’s College London (KCL), exploring avenues to decolonise higher education institutions (HEI). In 2021, GHSM executed a gap analysis of undergraduate modules, a course on decolonising research methods taught by global scholars to 40 Global South and North university students who completed pre- and post-course surveys, and semi-structured interviews with 11 academics as well as a focus group with four students exploring decolonising HEI.

(1) Gap analysis revealed a tokenistic use of Black and minority ethnic and women authors across modules’ readings. (2) The post-course survey showed that 68% strongly agreed the course enhanced their decolonisation knowledge. (3) The interviews highlighted five themes around what is decolonisation, what decolonising the curriculum should look like, how can we transform HEI, and how can we decolonise research.

Decolonising HEI must be placed within a human rights framework. HEI should integrate anti-racism agendas, give prominence to indigenous and marginalised histories and ways of knowing, dismantle power asymmetries, and create a non-hierarchical educational environment, with students leading the decolonisation process.

Read the article here.

Chemonotes

By Harry M. Marks

Professor Harry M. Marks, faculty member in the Department of History of Medicine at Johns Hopkins University since 1989, died on 25 January 2011, aged 64. He served on the editorial board of Social History of Medicine and was a generous and exacting reviewer for the journal. As a memorial to Pr. Marks, some of his extraordinary personal reflections during his time as an outpatient undergoing treatment for prostate cancer were collated. He periodically emailed these musings to family members, friends and colleagues. At a memorial celebration held in Baltimore in February 2011, Gert Brieger observed that Harry Marks lived his life as if in a ‘perpetual teaching moment’. These emails stand in testament not only to that, but also to Marks’ rapacious intellectual curiosity, rasping critique, sense of humour, and, not least, remarkable fortitude.

Read his reflections here.

Latin America at the margins? Implications of the geographic and epistemic narrowing of ‘global’ health

By Amaya Perez-Brumer, David Hill and Richard Parker

Picture: Roberto Huczek

To explore the narrowing of the concept of ‘global’ in global health, this article traces how Latin America has held a place of both privilege and power as well as marginalisation in the field. The authors employ a modified extended case method to examine how Latin America has been ‘seen’ and ‘heard’ in understandings of global health, underscoring the region’s shifting role as a key site for research and practice in ‘tropical medicine’ from the mid-nineteenth century through World War II, to a major player and recipient of development assistance throughout the ‘international health’ era after World War II until the late twentieth century, to a region progressively marginalised within ‘global health’ since the mid-1980s/1990s. They argue that the progressive marginalisation of Latin America and Southern theory has not only hurt health equity and services, but also demonstrates the fundamental flaws in contemporary ‘global’ thinking. The narrowing of global health constitutes coloniality of power, with Northern institutions largely defining priority regions and epistemic approaches to health globally, thus impoverishing the field from the intellectual resources, political experience, and wisdom of Latin America’s long traditions of social medicine and collective health.

Read article here.

Demographic Anxieties in the Age of ‘Fertility Decline’

By Silvia De Zordo, Diana Marre and Marcin Smietana

This double special issue sheds light on the “demographic anxieties” provoked by the articulations of major social and political-economic processes that have affected reproductive politics (Ginsburg and Rapp 1991) and practices over the last decades around the world, in particular: fertility decline, the simultaneous development of sophisticated prenatal and assisted reproductive technologies (ARTs), and the austerity policies adopted after the 2008 economic crisis on a global scale, in a context of rising nationalism. The authors explore demographic anxieties concerning, on the one hand, fertility decline, the postponement of motherhood and population aging, and, on the other hand, the reproductive behavior of specific social groups (e.g., religious/ethnic minorities and low-income populations). They illustrate how these anxieties emerge and are mobilized as mechanisms of reproductive governance across the global North and South (Fonseca et al. 2021; Morgan and Roberts 2012), in contexts marked by growing social inequalities resulting from the application of neo-liberal policies and austerity measures, which make reproductive choices, and futures, increasingly difficult and precarious.

Read the full article here.

Between a Rock and a Hard Place: Ethics of Fieldwork in Northwest Pakistan

By Ping-hsiu Alice Lin

Photo: Ihtasham Ali

In the wake of the US-led and Pakistan-allied “war on terror”, residents in Northwest Pakistan have faced inconceivable structural and physical violence, in ways that pose ethical challenges in ethnographic writing and research. Over the last few decades, militancy, banditry and overall insecurity have hampered relief efforts in the area and significantly weakened basic infrastructure. In this article, the author illustrates how an initial security plan to undertake fieldwork research in this “volatile” region proved somewhat irrelevant because of her positionality, gender and race/ethnicity. The author explores the implications of these dynamics in contexts characterized by unequal gender relations and strict gender segregation. In addition, undertaking empirical work in the context of epistemological frameworks in a region that has been subjected to active conflict, militarised operations and a singular representation in the global and local media, poses other ethical challenges for anthropologists searching for new areas of study and decolonised models of representation. This paper reiterates the importance of a reflexive approach of ethics that acknowledges the interpenetration of race, gender and the thick web of relationships in the production of knowledge and is, at the same time, respectful of cultural specificity.

Read more here.

Social Exclusion and Care in Underclass Japan: Attunement as Techniques of Belonging

By Jieun Kim

While Japan boasts a universal healthcare system and state-of-the-art medical technology, healthcare has often been denied to those who do not conform to moral ideals of a deserving patient. In underclass enclaves known as yoseba (day laborers’ quarter), patients have been frequently turned away or blacklisted on grounds of their abnormality and non-compliance. As much as healthcare was enmeshed in the normative bonds of family and community sanctioned by the state, yoseba men were considered as outsiders who neglected their duties of care, thus, undeserving of any form of care themselves. Focusing on the struggle for healthcare in a yoseba enclave in Yokohama over the past three decades, this paper explores how various practices of care have been improvised in this last refuge for the underclass men. The relentless endeavor pursued by local medical activists reveals how attending to yoseba patients required creative techniques of spatio-temporal attunement to make healthcare a communal project. Here, a form of “embodied belonging” was sought through bodily care coordinated among various agents and things, rather than through claims for membership in a bounded entity.

Read more here.

The migrant’s time

By Ranajit Guha

Rethinking the concepts of migration and diaspora, Ranajit Guha focuses on the loss of one’s past and identity resulting from the temporal and spatial distortions imposed by migration. In addition to discussing the migrant’s status at the initial departure, Guha reflects on the migrant’s experience within the host community in the intensity of the immediate present. Suddenly ruptured from the continuity of their own roots, disoriented and with no insights in an incomprehensible present that has no before nor after, migrants are expected to struggle to build themselves a future and a new identity.

Read more here.

Maternal Mortality in Rural Bangladesh: Lessons Learned from Gonoshasthaya Kendra Programme Villages.

By Rafiqul Huda Chaudhury and Zafrullah Chowdhury

The present study examines the experiences and health care strategies of Gonoshasthaya Kendra (GK), the first NGO to tackle rural health care delivery in Bangladesh, in reducing maternal mortality. A close scrutiny of the GK experience shows that reduction in maternal mortality in rural Bangladesh is possible, even while keeping the place of delivery at home and at a low cost, with the support of trained traditional birth attendants provided (a) they are integrated into the formal rural health delivery system, through which they are linked with local-level-government trained health workers for effective supervision and referrals and (b) a system of accountability is institutionalized by which trained traditional birth attendants along with health workers are accountable to their supervisors and the community they serve through village health committees and local government. The GK experience of involving village-level trained paramedics and trained traditional birth attendants in the rendering of maternal and child care services can be replicated by the Government through improving skills of traditional birth attendants in pregnancy management through continuing in-service training and linking them with the existing reproductive health care systems. The finding calls for a fundamental shift in the current nature of public service provision in Bangladesh to make public service providers directly accountable at the local level. Further reduction in maternal mortality is possible in rural Bangladesh through vigorous campaigns against smoking, prevention of births to women with four or more children, the delay of births to primigravidas, prevention and treatment of anaemia, and promotion of full doses of tetanus vaccines for pregnant women.

Read more here.

Towards decolonising research methods training: the development of a locally responsive online learning course on research methods for mental health in war and conflict for researchers and practitioners in the Gaza Strip

By Nancy Tamimi, Hanna Kienzler, Weeam Hammoudeh, Hala Khalawi, Mathias Regent and Rita Giacaman

Background

Concerns exist that online learning directed at non-Western settings to strengthen research capacity imposes Western-centric epistemology, provides unidirectional transfer of knowledge, and neglects local paradigms and expertise. We argue that a plurality of voices, histories and epistemologies are essential to strengthen research capacity. We share our experience developing and teaching an online course for mental health professionals and researchers in the Gaza Strip.

Methods

Birzeit University and King’s College London developed and delivered the course equally, focusing on the intersection between qualitative research methods, mental health and conflict, and addressing local research needs. We incorporated local case studies and expertise, encouraged interaction in English and Arabic, and stimulated critique of Western theories. Seventeen participated, 12 completed the pre-course questionnaire, 15 completed the post-course questionnaire and four undertook semi-structured interviews.

Results

Our pre-course survey showed participants most needed coding and qualitative data analysis skills. Post-course findings showed improved qualitative research skills. Most agreed the course was comprehensive and well delivered, with relevant case studies. Three themes were identified: (1) the course was locally contextualised and met students’ needs; (2) the course fostered dialogic and multi-directional learning and (3) suggestions for improvements. Several participants wanted some topics in greater depth and further specialised training. A few suggested the course be in Arabic.

Conclusion

Fostering multi-directional learning is key for non-Western knowledge, epistemologies, and languages to gain prominence in Western academia. A social transformation would see local researchers and educators engage with and use local methods and paradigms in mental health in war and conflict.

Read more here.

Create a website or blog at WordPress.com

Up ↑