Paper short abstract:

Explores the complexities of teaching students from a wide range of backgrounds about experiences of 'marginalisation' and the paradox of failing students who cannot describe their own exclusion in sufficiently academic terms.

Paper long abstract:

A progressive teaching agenda derived from World Health Organisation research on the social determinants of health and set against a background of the Rudd government's agenda on health raises questions about the experiences of teaching and learning for nursing students from a wide range of educational backgrounds. Sociologists and anthropologists present diversity and disadvantage with the humanist agenda of provoking empathy and underpinning future patient centred practice. They are teaching about experiences shared by many in the audience who have enrolled with the intention of changing their circumstances. This paper reflects on the experience of addressing students about their own life experience and questions the extent to which this curriculum addresses or reinforces marginality. It also raises the discomfort of reinforcing the moral superiority of privileged students; in popular culture, those examining such material may be accused of indulging in 'poverty porn'. The final irony is that privileged students are more able to express their understandings of marginalisation in elaborated code while students who cannot describe their own experience in this way risk failure.

Paper short abstract:

The process of negotiating hospital ethnographic research includes an ethics committee and various gatekeepers in several departments. Exposed are myriad ways in which biomedical practitioner power diverts, obfuscates and hinders an anthropological exploration into patient cultural diversity.

Paper long abstract:

Anthropological studies of biomedicine often critique the medicalized dominance of western medicine versus other ethnomedicines, the healing practices of non-western societies or alternative therapies. Hospitals are viewed as 'islands' (Coser 1962) or liminal spaces (Turner 1977; van der Geest 2005; 2006; Livingstone 2012), and others that contain specialized clinical knowledge and practices - spaces in which patients have sojourns and return to 'normal life' or remain and progress to palliative care, followed by death (Long et al. 2008; Finkler et al. 2008). It is only in the last two decades that social scientists have fully engaged in or entered the biomedical domain (Fox 1980). The purpose of this paper is to comment on the process and subsequent machinations of negotiating an ethnographic research project in a tertiary level teaching hospital in Australia that includes an ethics committee and various gatekeepers in several departments. The paper exposes the myriad ways in which practitioner power in a biomedical model is used to divert, obfuscate and hinder an anthropological exploration into the cultural diversity of patients. There are examples of questionable professional behavior, time-lags, false notions of concern for patient safety, and seeming under enthusiasm for outsider research.

Paper short abstract:

A smoke(free) anthropology? A good deal of the present anthropological refusal to deal with smoking outside of a public health-aligned commitment to reducing it.

Paper long abstract:

A smoke(free) anthropology?

A good deal of the present anthropological refusal to deal with smoking outside of a public health-aligned commitment to reducing it, has to do with fears over how any research which produces findings critical of public health aims may be pressed into the service of pro-tobacco interests. Thus, anthropological work has largely refused to offer insight beyond a commitment to ending the global tobacco epidemic. My attempt to differently conceptualize smoking and the atmosphere in which it is conducted is one characterized by attendance to the relations between the 'largeness' of the smokefree atmosphere and the minuteness of bodily processes that a smokefree agenda seeks to influence. Here I refer to things like the state's concern with protecting the quality of the air itself and the minute and intimate relations this concern produces, namely with the body of the smoker, and with the air in which she is enveloped as she smokes - and particularly with her breath. I am concerned with our relations to the air, and how they can be explicated to foreground understandings of the air that become dominant, and can be put to political use.

Paper short abstract:

Ethnographic explorations of equity in access to contraceptive technologies among immigrant and refugee Australians

Paper long abstract:

Having more reproductive health issues, immigrant and refugee women are less familiar with the reproductive health services in the host country, are less aware of the available contraceptive technologies, have limited information on them in their own language, have communication problems related to language barrier and do not prioritize their reproductive health needs. According with the United Nations Population Fund, access to contraceptive technologies is considered an essential human right. Australian health services researchers highlighted the need to focus on vertical health equity that is appropriate unequal treatment of unequal population groups. This presentation is based upon an ARC Funded Linkage project on the use of contraceptive technologies and reproductive choice among immigrant and refugee women in Australia. This project being conducted by staff of the School of Social Sciences at Monash University, The Multicultural Centre for Women's Health, The Centre for Culture, Ethnicity and Health, and Sexual Health and Family Planning Australia and explored women's experiences of use of conventional and new contraceptive technologies. A total number of 84 immigrant women from various ethnic backgrounds and 16 service providers were recruited for qualitative interviews. Presenting findings, we will focus on cost of contraceptive technologies, availability of printed information in ethnic languages, waiting list for selected contraceptive technologies and issues related to interpreting in health settings. Findings from this project will be utilized by collaborating organizations to reduce inequities in family planning service provision and access to contraceptive technologies.

Paper short abstract:

Aboriginal oral health, practitioner explorations of equity and health, critical medical anthropology

Paper long abstract:

Despite dental caries being largely preventable, Aboriginal Australians have worse periodontal disease, more decayed teeth and untreated dental caries with Aboriginal children reported as having twice the rate of dental caries as non-Aboriginal children. Public health messages to reduce sugar intake, brush and floss teeth regularly and stop smoking have failed to significantly reduce disparities raising questions of where the problem lies. Qualitative research examining 35 Aboriginal Health Workers' perceptions of oral health in Aboriginal communities in Perth Western Australia revealed structural and socioeconomic barriers that were explored through the lens of 'access to services' using Harris' model of opportunity, use, equity and outcomes. Opportunities for accessing public dental services were noted as limited with long waiting lists and emergency hospital services a last resort for severe pain, often resulting in dental extraction; use of public or private dental services was constrained by cost, distance and health providers' sometimes discriminatory attitudes;. Outcomes from such constraints included self-medication for pain, fear of tooth extraction and shame about dental appearance. Most dental services are located within a neoliberal framework focusing on cost-effectiveness, profit and individual responsibility to make optimum health choices. According to Ulrich Beck, penalties for 'non-compliance' are blame and 'personal failure'. Addressing this as a moral issue requires policy makers and health providers to critically reflect on policies and practices that reproduce inequities in Aboriginal oral health, review failed service approaches and change the discourse that places Aboriginal people at the centre of the problem.

Paper short abstract:

An ethnographic approach to exploring access to prenatal care, specifically information about male circumcision, in non-profit clinics among Latina mothers in the US. This study analyses the effect of evidence-based health policies on service delivery to a migrant and underserved population.

Paper long abstract:

This paper will discuss how anthropology can contribute to understanding the impact of health services on male circumcision (MC) in the United States.

Epidemiological research in the last decade suggests a link between MC and a reduction in HIV transmission among heterosexual males. Consequently, the American Academy of Pediatrics and Centers for Disease Control and Prevention changed their previous policy stances on MC, and now recommend that parents be fully informed of the procedure's benefits.

I conducted my ethnography in three clinics in the suburbs of Washington, DC. I investigated how evidence-based policy making affects service delivery in non-profit clinics serving migrant and uninsured populations; specifically, how discussions about MC occur during prenatal care among Latina mothers.

I found that informed decisions about MC demonstrated inequity. Latina women did not receive information regarding MC from the clinics, and relied on familial and casual networks of information. The clinics' staff did not consistently offer information about MC because of structural factors such as limited resources, lack of time, and their perception that MC was a 'cultural' topic rather than a medical one. Thus, the power of Latinas to make informed decisions was affected by the beliefs and practices of healthcare providers.

As a Latino anthropologist in an environment dominated by Latina employees and clients, I had a privileged position to study this topic. My ethnographic approach allowed me to explore the cultural context of local service access, in a way that epidemiological research and ensuing policy often fail to consider.

Paper short abstract:

Explores the paradox between the competing needs of women effected by violence, and the biomedical framework's demand for full disclosure.

Paper long abstract:

Violence against women has recently been described as an Australian 'epidemic', (further) cementing its place within biomedical discourse. Yet, chronic underreporting remains a primary obstacle for service providers to tackle the problem.

Attempts to incorporate female lived experiences within the biomedical framework are notoriously fraught and have been criticised as iatrogenic (harm-causing). In interviews with women who had experienced violence, I asked what precisely they needed to feel/be safe when discussing their experiences and whether they made official reports. The theme of 'safe spaces' was unanimously agreed upon, and the lack of anonymous reporting meant that few reported attacks, either to health professionals or legal services.

The fear of incurring legal intervention was too high a risk, and was a barrier from seeking medical help. This suggests a systemic paradox of anonymity versus explicit disclosure, which could explain chronic underreporting.

From an anthropological perspective working within a multidisciplinary space, looking at the relationship between women's lived experiences of violence and health agencies, I suggest the combination of anonymous disclosure that these women designate as essential, with what can be argued as a moral imperative for service providers to protect clients from further harm, can be accomplished as a by-product of rigorously applied ethnographic methodological practice.

The paradox of ethnography—that we engage and have relationships with our participants, as well as provide them with anonymity—can address the paradoxical structural requirement for women to announce their 'victimhood', with health practitioners' imperative to prevent further harm.

Paper short abstract:

This paper explores structures of muting and institutional prejudice within prestige hierarchies in medicine. Solid, biomedical epistemologies are examined and fluid alternatives suggested to better serve patient-centred healthcare.

Paper long abstract:

Prestige hierarchies are taken for granted in clinical medicine. From the earliest days, medical students and doctors are enculturated into a professional hierarchy which whilst effective on some levels has also been associated with institutional prejudice and the muting of the voices of those who are considered subordinate. A recent study of 163 Melbourne doctors found that less than half were willing to question a 'superior doctor' even if an error was occurring. (Dendle et al, 2013)

Co-authored by five medical students who use an anthropological framework to explore medical hierarchies, this paper examines medical prestige from the perspective of solid epistemologies as are commonly found in biomedicine and the associated muting of voice which can ensue. It suggests that alternative fluid models exist which better serve an evolving paradigm of patient-centred medical care.

Paper short abstract:

This paper explores metaphors for AIDS and its potential use as a metonym for structural violence. Engaging the power of metaphoric and metonymic thinking in constructive ways may potentially mitigate stigma and facilitate a deeper, holistic understanding of the disease and its management.

Paper long abstract:

Beyond Sontag: Metaphors, Metonyms and the AIDS pandemic

In the 1980's Susan Sontag famously coined the phrase "Illness as Metaphor." In her exploration of metaphors within popular culture pertaining to cancer, TB and AIDS, she directly associated these metaphors with stigmatization of the chronically ill and argued firmly against metaphoric thinking, seeking a 'wholesome dedramatization' of AIDS so that a "specific dreaded illness (could) come to seem ordinary".

In 2015 HIV/AIDS has reached pandemic proportions. Whilst denigrating metaphors persist, many claim that diminishing HIV to 'just another' illness is as unhelpful as sensationalist rhetoric. As HIV positive gay scholar David Caron writes "to have HIV isn't a catastrophe but it isn't nothing either". This paper explores both potentially stigmatizing and empowering metaphors for AIDS and the reframing of AIDS as a metonym for structural violence. Engaging the power of metaphoric and metonymic thinking in constructive ways may potentially mitigate stigma and facilitate a deeper, holistic understanding of the disease and its management.

Paper short abstract:

Exploring shifts from imperatives to ‘Unlearn How to Not-Speak’ to demands that those who benefit from structural violence start to ‘Unlearn How to Not-Hear’.

Paper long abstract:

Structural Violence; harm caused by systemic, structural impediments to people being able to meet their basic needs; is comprised of uses and abuses of power that can be both insidiously complex and frighteningly straightforward. This paper explores ways in which beliefs and practices around what is unsaid and unsayable contribute to systemic structural violence.

Firstly, I will explore examples of un-muting from popular culture (such as the articulation of slut-shaming discourses), and from biomedical culture (such as resistances to medical dominance). I then examine recent discourses around acknowledgement of privilege. I suggest there is a shift occurring from expectations that people disadvantaged by structural violence 'Unlearn How to Not-Speak' to a moral imperative that demands that those who benefit from structural violence 'Unlearn How to Not-Hear'.