Patient’s Perspectives on Hospitalisation: Experiences from a Cancer Ward in Kenya

By Benson A. Mulemi

This paper explores how adult cancer in-patients feel about and make sense of their condition and therapy. Data was collected through observation and informal conversations with patients and hospital staff, over a period of 12 months, on a cancer ward in a teaching hospital in Kenya. Mulemi held in-depth conversations on multiple occasions with 42 patients. Most of them expected to recover quite fully, despite having postponed seeking medical help, and delays in referral. Long periods of suffering, prolonged diagnosis and treatment, and socio-economic difficulties shape the patients’ perspectives on hospitalisation. The low position of patients in the social and medical hierarchy, and inadequate hospital resources, hamper their capacity to negotiate their care. The needs of the cancer patients can better be met when their experiences during hospitalisation are understood. This can foster co-operation between patients and hospital staff to facilitate coping with chronic illness. The patients’ views highlight both material and non-material needs in cancer management in a developing country.

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The Political Stakes of Cancer Epistemics

By Shagufta Bhangu, Violeta Argudo-Portal, Luiz Alves Araújo Neto, Thandeka Cochrane, Masha Denisova, Nickolas Surawy-Stepney.

The authors demonstrate a transnationally situated dialogue as a method to bring ethnographic and historical research in Brazil, East Africa (Kenya, Tanzania and Uganda), India, Russia and Spain into conversation to show three cancer epistemics sites (research, detection, and care access) where the politics of cancer epistemics are at play. First, in the field of research, they show how certain ways of knowing, and certain questions about and interests in cancer, are privileged over others. Using examples from Spain and East Africa, they highlight how a shift towards microbiological and high-technology research has outpriced many more locally grounded research agendas, ignoring questions of industrial and capital accountability in cancer aetiology. Second, they look at ways of making cancer visible, how knowledge is mobilised in cancer detection and screening, where and for whom. The authors discuss the increased individualisation of risk which is reframing cancer surveillance and therapeutic agendas. Using examples from India, Spain and Brazil, the authors demonstrate how the epistemics of cancer detection generate discourses of blame and responsibility at the individual level and accentuate existing inequities whilst simultaneously absorbing patients and their families into complex networks of surveillance. Lastly, they examine how the epistemics of cancer implicate the very possibilities of accessing cancer care, shaping care pathways and possibilities for patients. With ethnographic examples from India, Russia and Brazil, the authors demonstrate how an orientation towards the individual shifts attention away from the commercialisation of healthcare and dominance of logics of profit in therapeutics.

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