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Apprenticeship, Or Learning to Be An Expert 学徒制,或者学习成为专家
Pub Date : 2022-03-28 DOI: 10.17157/mat.9.1.6993
Vania Smith-Oka
Commentary to the special issue 'Therapeutic Apprenticeship: Uncovering Truth and Performing Responsibility' by Vania Smith-Oka.
Vania Smith Oka的特刊《治疗学徒:揭露真相和履行责任》评论。
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引用次数: 0
Eyes in Sight: Embodiment, Affect, and Learning to See in Ophthalmology 视觉中的眼睛:在眼科学中的体现、影响和学习看
Pub Date : 2022-03-28 DOI: 10.17157/mat.9.1.5480
Adam D Baim
Vision is central to the apprenticeship of ophthalmology residency training. As clinicians who diagnose and treat diseases of the eye, ophthalmologists build their professional identities around the mission of safeguarding their patients’ sight. At the same time, ophthalmologists rely on their own vision as they peer into the eye to detect subtle signs of disease. Based on an extended ethnography of an ophthalmology residency programme, as well as autoethnographic analysis of ophthalmology training, this article explores how novice trainees learn to view the eye by considering two fundamental examination techniques. The first is slit lamp biomicroscopy, where a table-mounted microscope is used to view ocular structures in fine detail. The second is binocular indirect ophthalmoscopy, where examiners view the retina using a head-mounted instrument in conjunction with handheld lenses. Rather than framing visual interpretation as a cognitive exercise in identifying pathology, I instead consider these techniques as embodied practices where trainees must discipline their movement, attention, and use of instrumentation to make the eye visible. This process of embodiment, in turn, unfolds within a broader terrain of affects as trainees marvel at what they behold, yearn to see more, and fear the limitations of their own vision while they learn to perform challenging examination manoeuvres. Situating the ophthalmic examination in its embodied and affective contexts illustrates the sensibilities that ophthalmology residents come to inhabit during their apprenticeship and which undergird the visual expertise of ophthalmologists.
视力是眼科实习培训的核心。作为诊断和治疗眼部疾病的临床医生,眼科医生围绕着保护患者视力的使命建立自己的职业身份。与此同时,眼科医生在凝视眼睛时依靠自己的视力来检测疾病的细微迹象。基于眼科住院医师项目的扩展民族志,以及眼科培训的民族志分析,本文探讨了新手学员如何通过考虑两种基本的检查技术来学习观察眼睛。第一种是裂隙灯生物显微镜,使用台式显微镜观察眼部结构的细节。第二种是双目间接检眼镜,检查人员使用头戴式仪器和手持镜片观察视网膜。我没有将视觉解释视为识别病理学的认知练习,而是将这些技术视为具体实践,受训者必须训练他们的动作、注意力和仪器的使用,以使眼睛可见。反过来,当受训者在学习进行具有挑战性的考试操作时,惊叹于自己所看到的,渴望看到更多,并害怕自己视野的局限性时,这种具体化的过程会在更广阔的情感领域中展开。将眼科检查置于其具体和情感背景中,说明了眼科住院医师在学徒期间的感受,并为眼科医生的视觉专业知识奠定了基础。
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引用次数: 0
Making Apprenticeship Training Visible 使学徒培训可见
Pub Date : 2022-03-28 DOI: 10.17157/mat.9.1.6992
Rachel Prentice
Commentary to the special issue 'Therapeutic Apprenticeship: Uncovering Truth and Performing Responsibility' by Rachel Prentice.
评论特刊“治疗学徒:发现真相和履行责任”由雷切尔·普伦蒂斯。
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引用次数: 0
Introduction: Diagnostics, Medical Testing, and Value in Medical Anthropology 导论:医学人类学的诊断、医学检验和价值
Pub Date : 2021-11-03 DOI: 10.17157/mat.8.2.6516
A. Street, A. Kelly
Introduction to the Special Issue on Diagnostics, Medical testing, and Value
诊断学、医学检测和价值特刊导论
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引用次数: 7
Moments of Uncertainty: Exploring How an App-Based Oral HIV Self-Testing Strategy Fits in Communities ‘Living Under’ HIV Risk 不确定性时刻:探索基于应用程序的HIV口腔自检策略如何适应“生活在”HIV风险下的社区
Pub Date : 2021-11-03 DOI: 10.17157/mat.8.2.5134
Ricky Janssen, A. Krumeich, A. Esmail, Réjean Thomas, K. Dheda, Nitika Pant Pai, N. Engel
Feasibility and acceptability research for HIV self-testing (HIVST) often emphasises the importance of good test conduct and correct test interpretation for knowing one’s HIV result while overlooking the ways in which different uncertainties and meanings emerge around testing. Using empirical examples from a quantitative study assessing an app-based strategy in Cape Town, South Africa, this research article explores the practice of HIVST and how people deal with uncertainties while using the app in question, named ‘HIVSmart!’. We use the concept of ‘living under’ to explore the practices of HIV testing for those who fit the definition of being ‘at risk’ of HIV (note that an individual’s HIV status must be unknown in order for them to fit this definition) and to understand how an app-based HIVST strategy fits within these practices. We show how the app and oral self-test—as well as knowledge around HIV risk behaviours, comparisons between different testing methods, and the guidance and presence of healthcare staff—alleviate as well as generate uncertainty and constitute HIV status as an ongoing process. The effective implementation of new strategies for HIVST requires consideration of multiple aspects of the testing process, including local understandings of HIV risk, access to healthcare staff, and the meaning of certain test methods within a particular context.
HIV自我检测(HIVST)的可行性和可接受性研究通常强调良好的检测行为和正确的检测解释对了解自己的HIV结果的重要性,而忽略了检测中出现不同不确定性和意义的方式。这篇研究文章使用了南非开普敦一项评估基于应用程序策略的定量研究的实证例子,探讨了HIVST的实践,以及人们在使用名为“HIVSmart!”的应用程序时如何应对不确定性。我们使用“生活在”的概念来探索那些符合“有感染艾滋病毒风险”定义的人的艾滋病毒检测实践(注意,为了符合这一定义,个人的艾滋病毒状况必须未知),并了解基于应用程序的HIVST策略如何符合这些实践。我们展示了该应用程序和口腔自检,以及有关艾滋病毒风险行为的知识、不同检测方法之间的比较,以及医护人员的指导和在场情况,如何缓解和产生不确定性,并将艾滋病毒状况视为一个持续的过程。有效实施新的艾滋病毒/艾滋病病毒检测策略需要考虑检测过程的多个方面,包括当地对艾滋病毒风险的理解、接触医护人员的机会,以及特定背景下某些检测方法的意义。
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引用次数: 1
Detecting Diabetes Risk: Philanthrocapitalism, Diagnostic Innovation and Epistemic Power in Mexico 糖尿病风险检测:墨西哥的慈善资本主义、诊断创新和认识力
Pub Date : 2021-11-03 DOI: 10.17157/mat.8.2.5138
Emily E. Vasquez
An expanding class of mega-philanthropic institutions, most often based in the Global North but increasingly based in the Global South, has emerged as a driving force in global health. Among them, the Carlos Slim Foundation—located in Mexico City and funded by Mexican-born telecommunications tycoon Carlos Slim Helú—has spearheaded an ongoing strategy to boost chronic disease prevention in Mexico, principally through the development and promotion of a series of cutting-edge diagnostic tests. In this research article I trace the Foundation’s efforts to develop these technologies and integrate them into Mexican health policy. With these technologies serving as powerful conduits of the Foundation’s epistemic power, I show that Carlos Slim’s philanthropic investments are reshaping goals in the public health field and fostering new understanding of chronic disease risk among health officials and experts in Mexico and beyond.
越来越多的大型慈善机构已成为全球卫生的推动力,它们通常位于全球北部,但越来越多地位于全球南部。其中,卡洛斯·斯利姆基金会(Carlos Slim Foundation)位于墨西哥城,由墨西哥出生的电信大亨卡洛斯·斯里姆·赫卢(Carlos Slim Helú)资助。该基金会率先制定了一项正在进行的战略,主要通过开发和推广一系列尖端诊断测试来促进墨西哥的慢性病预防。在这篇研究文章中,我追踪了基金会开发这些技术并将其纳入墨西哥卫生政策的努力。这些技术是基金会认识力的强大渠道,我表明卡洛斯·斯利姆的慈善投资正在重塑公共卫生领域的目标,并促进墨西哥及其他地区的卫生官员和专家对慢性病风险的新理解。
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引用次数: 1
Molecular Sovereignty: Building a Blood Screening Test for the Brazilian Nation 分子主权:为巴西民族建立血液筛查测试
Pub Date : 2021-11-03 DOI: 10.17157/mat.8.2.5122
Koichi Kameda
This article interrogates the relationship between the development of national diagnostic technologies and the exercise of sovereignty, by analysing a Brazilian project to produce a nucleic acid test (NAT) for the country’s blood screening programme. The concept of ‘molecular sovereignty’ is proposed to demonstrate that exercising sovereignty demands not only technological resources but also a sufficiently powerful and national imaginary to support local knowledge production as a means of advancing national healthcare priorities. First, this research article contextualises the political importance of blood safety for Brazil during its transition to democracy in the 1980s and the creation of its universal healthcare system. Then, it investigates how adopting the NAT led the state to invest in the production of a national technology. Third, the article unpacks the diagnostic test to consider how certain aspects of the project might ultimately strengthen the ability of global capital to cross national boundaries and create new markets. Lastly, it discusses how the project ended up creating a centralised and ‘closed’ system to avoid leaving the country vulnerable to the entry of global diagnostic companies. This case demonstrates how the molecularisation of blood, through the construction of a unified healthcare system driven by the constitutional right to health, can be deployed to construct imagined communities on the scale of a nation.
本文通过分析巴西为该国血液筛查计划生产核酸检测的项目,探讨了国家诊断技术的发展与主权行使之间的关系。提出“分子主权”的概念是为了证明行使主权不仅需要技术资源,还需要足够强大的国家想象,以支持当地知识生产,作为推进国家医疗保健优先事项的手段。首先,这篇研究文章阐述了血液安全对巴西在20世纪80年代向民主过渡和建立全民医疗体系期间的政治重要性。然后,它调查了采用NAT是如何导致国家投资于一项国家技术的生产的。第三,文章开启了诊断测试,以考虑项目的某些方面如何最终加强全球资本跨越国界和创造新市场的能力。最后,它讨论了该项目如何最终创建了一个集中和“封闭”的系统,以避免该国容易受到全球诊断公司的进入。这个案例展示了如何通过构建由宪法健康权驱动的统一医疗体系,将血液分子化,以构建一个国家规模的想象社区。
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引用次数: 4
The Testing Database as Pandemic Technology: Reflections on the COVID-19 Response in India 作为流行病技术的测试数据库:对印度新冠肺炎应对措施的思考
Pub Date : 2021-11-03 DOI: 10.17157/mat.8.2.5105
Sreya Dutta Chowdhury, R. Basu
This article examines the COVID-19 response in India, viewing it as deeply enmeshed in the dynamics of the ‘database’ as an emerging technology of governmentality. Databases aim to translate entire populations into units of information abstracted from social identities and local specificities. In the context of the coronavirus pandemic, bureaucratic state systems attempt to manage and respond to the health crisis via databases collating testing data across the country. Problematising COVID-19 testing databases, we delve into the logic of database governance. We find that as a tool of governance the database falters in its attempts to compress complex identities and locations into de-contextualised units of information. As the complexity of lived reality interrupts the logic of databasing, state discourse on ‘unintended consequences’, ‘leakages’, ‘duplication’, and ‘reconciliation’ processes in the management of databases abounds and the ambivalence of databases becomes manifest in the COVID-19 response. In this article, we use secondary data to understand how testing databases intervene and interact with complex realities to establish bureaucratic order around a pandemic. We posit that COVID-19 testing databases should be understood as being embedded in emerging database governmentalities that supplant care of the population with the maintenance of databases.
本文考察了印度的COVID-19应对措施,认为它作为一种新兴的治理技术,深深融入了“数据库”的动态。数据库旨在将整个人口转化为从社会身份和地方特征中抽象出来的信息单位。在冠状病毒大流行的背景下,官僚国家系统试图通过数据库整理全国各地的检测数据来管理和应对卫生危机。针对新冠肺炎检测数据库问题,深入研究数据库治理逻辑。我们发现,作为一种治理工具,数据库在试图将复杂的身份和位置压缩为非上下文化的信息单元时步履维艰。由于生活现实的复杂性打断了数据库的逻辑,国家对数据库管理中的“意外后果”、“泄漏”、“重复”和“和解”过程的论述比比皆是,数据库的矛盾心理在COVID-19应对中表现出来。在本文中,我们使用辅助数据来了解测试数据库如何干预并与复杂的现实相互作用,以建立围绕流行病的官僚秩序。我们认为,COVID-19检测数据库应被理解为嵌入新兴的数据库政府,以数据库维护取代对人口的照顾。
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引用次数: 0
Long-term Care Hospitals and Changing Elderly Care in South Korea 韩国长期护理医院与老年护理的变革
Pub Date : 2021-09-28 DOI: 10.17157/mat.8.3.5084
S. Na
Until recently in South Korea, the central dilemma facing children with ageing parents was how and by whom their parents should be cared for. In accordance with the norm of filial piety, the eldest son used to take responsibility. However, with the recent proliferation of long-term care hospitals, this arrangement is changing. These institutions, which play the combined role of rehabilitative hospital, long-term care centre, and nursing home, admit elderly people who do not require active medical intervention. The government’s promotion of these hospitals, centred on deregulation, ambiguity around their function, and the lack of alternative care facilities, has led to an expansion of the sector and consequently to the ‘nursing hom(e)fication’ of many of these institutions. While these hospitals ease the pressures associated with an ageing population, their mainstreaming has had an impact on healthcare, medicine, and the lives of elderly people. The hospital field has become commercialised, medical practice is being transformed, and the dignity of elderly people is being lost through hospitalisation. In this new care regime, filial piety itself is undergoing transformation—from an ideology underpinning the domestication of care, to the market idiom of service compliance. In this article, I introduce these hospitals and investigate how their growth has brought about a Korean style of elderly care commodification, revealing the undercurrents of healthcare privatisation and the neoliberalisation of welfare.
直到最近,在韩国,父母年迈的儿童面临的核心困境是如何以及由谁照顾他们的父母。按照孝顺的准则,长子过去常常承担责任。然而,随着最近长期护理医院的激增,这种安排正在发生变化。这些机构发挥着康复医院、长期护理中心和疗养院的综合作用,接纳不需要积极医疗干预的老年人。政府对这些医院的推广,集中在放松管制、职能模糊以及缺乏替代护理设施上,导致了该行业的扩张,从而导致了许多此类机构的“护理人性化”。虽然这些医院缓解了与人口老龄化相关的压力,但它们的主流化对医疗保健、医学和老年人的生活产生了影响。医院领域已经商业化,医疗实践正在转型,老年人的尊严正在因住院而丧失。在这个新的照顾制度中,孝道本身正在经历转变——从一种支持照顾本土化的意识形态,转变为遵守服务的市场习惯。在这篇文章中,我介绍了这些医院,并调查了它们的发展如何带来了韩国式的养老商品化,揭示了医疗私有化和福利新自由化的暗流。
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引用次数: 1
“Doing it Our Way” Participation and Kinship in Traditional Surrogacy Narratives in Aotearoa New Zealand 新西兰奥特亚传统代孕叙事中的“按我们的方式做”参与与亲情
Pub Date : 2021-09-28 DOI: 10.17157/mat.8.3.5093
Hannah Gibson
The practice of traditional surrogacy gives rise to multiple discourses around women’s autonomy and kinship practices globally. In the Aotearoa New Zealand context, traditional surrogacy (where the surrogate donates her own egg as well as gestating the foetus) is legal only on an altruistic basis. Furthermore, it is subject to neither medical nor state oversight, unlike gestational surrogacy which is heavily regulated. Drawing on three years of ethnographic research, this article focuses on both traditional surrogates in Aotearoa New Zealand who have children of their own and those who have chosen a childfree life. Their narratives reveal multilayered motivations that align with and diverge from the ‘help’ narrative often associated with altruistic surrogacy. By drawing on and contributing to current debates on surrogacy globally, I show that traditional surrogates take on their role with clear ideas about kinship and different interpretations of reproductive participation. Their narratives bring to the fore the under-researched topic of traditional surrogacy, and in particular of women who do not want children of their own but choose to donate their eggs and gestate the foetus for another woman. I argue that their negotiation of stigma to make/resist kin disrupts pervasive heteronormative modes of kinship.
传统代孕的实践在全球范围内引发了关于女性自主性和亲属关系实践的多重论述。在新西兰的奥特亚,传统的代孕(代孕者捐赠自己的卵子并孕育胎儿)只有在无私的基础上才是合法的。此外,它既不受医疗监督,也不受国家监督,不像妊娠代孕受到严格监管。本文通过三年的民族志研究,重点关注新西兰奥特亚有自己孩子的传统代孕者和选择无子女生活的代孕者。他们的叙述揭示了多层面的动机,这些动机与通常与利他主义代孕相关的“帮助”叙述一致或不同。通过借鉴并参与当前全球关于代孕的辩论,我表明传统代孕者在扮演自己的角色时对亲属关系有着清晰的认识,对生育参与有着不同的解释。他们的叙述突出了传统代孕这一研究不足的话题,尤其是那些不想要自己的孩子但选择捐献卵子并为另一位女性孕育胎儿的女性。我认为,他们为建立/抵制亲属关系而进行的污名化谈判破坏了普遍存在的非规范亲属关系模式。
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引用次数: 2
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Medicine anthropology theory
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