Paper short abstract:

This paper addresses the complex realities of HIV-discordant couples living in Ethiopia. It identifies three realms of realities these couples face: epidemiological reality, reality of the locality, and reality of relatedness. Each realm involves a certain set of knowledge and ethics.

Paper long abstract:

Controlling the disease of the poor has become one of the central issues of global governance. Infectious disease epidemiology provides the fundamental knowledge underlying efforts of public health interventions to contain the spread of intractable viruses. Epidemiologists and public health experts are increasingly confident that they are developing efficient and inclusive mechanisms to control the global epidemic of HIV infection. What is less clear is how individuals living with HIV can maintain or develop affirmative relationships with the others and comprehend their lives as consistent and meaningful ones.

This paper addresses the complex realities of HIV-discordant couples living in rural Ethiopia. The experiences of these couples are often complicated because each individual faces questions simultaneously as a rational self, a moral person, and a lived body. This article identifies three realms of realities these couples face: epidemiological reality, reality of the locality, and reality of relatedness. Each realm involves a certain set of knowledge and notions of responsibility to others. Such responsibilities are indispensable to secure the continuity of certain realities, namely the health of the population and the reproduction of the locality. Yet these realities are hard to live with for a discordant couple whose relationship involves persistent health risk and moral questions. What makes the experiences of these couples more complicated are the ways in which the individuals' lives are interrelated, which often cannot be understood by referring to any existing category of morality or justice.

Paper short abstract:

In 2004, the National Health Insurance Scheme (NHIS) was introduced in Ghana. This health insurance, or anonymous mutual aid, not only replaces and undermines some face-to-face mutual aid practices but also entails others. This paper explores how this new technology impacts sociality.

Paper long abstract:

In 2004, the National Health Insurance Scheme (NHIS) was introduced in Ghana, and the scheme has since become widely used. This paper examines how this new technology of paying medical fees impacts the sociality and ecology of care.

Previous studies in the sociology of insurance have mainly explored chronological change and emphasize that insurance has atomizing effects and erodes face-to-face mutual aid practices. However, when closely examined, the coexistence of several types of mutual aid practices can be found, and such practices shape milieu through not only their juxtaposition but also sequentially relation. This milieu may be called an ecology of care for paying medical fees.

Health insurance in Ghana is rooted in medical policy history. From independence in 1958, a free medical service policy meant patients did not pay any medical fees. In this era, the government cared for people's health economically. Embracing structural adjustment policy in 1985, however, patients were confronted with the need to afford medical fees. However, people did not necessarily pay these fees by themselves, but used face-to-face mutual aid through kinship and friendship ties. Finally, as an extension of this neoliberal policy, Ghana's government introduced health insurance as a new method of payment.

This health insurance, which is anonymous mutual aid practice, not only replaces and undermines face-to-face mutual aid practices but also entails other types of mutual aid practices. Describing the milieu of mutual aid practices, this paper explores how this new technology impacts the sociality of the people concerned.

Paper short abstract:

In this paper I examine the process of changing attitudes and practices surrounding FC/FGM among the Kenyan Samburu pastoralists by showing cases and discourses over the newly created cutting styles.

Paper long abstract:

In this paper I examine the process of changing attitudes and practices surrounding FC/FGM among the people who had strongly maintained this custom. Kenyan Samburu is one of the ethnic groups who are strongly maintaining FC/FGM practice. They relate it to female maturity and fertility, and without circumcision women are not mature enough to give a birth, and women are usually circumcised on the day or before the day of marriage. If a child conceived by uncircumcised girl, it is called ngosenet, and people are afraid of it as an ominous existence which would destroy all the people of the family. This conventional belief is deeply held by every generation of both male and female. Therefore so many efforts made by international and national FGM abandonment projects have long seemed ineffective.

Recently, however, things have begun to change slowly according to the social changes. New cutting styles which are less mutilating than traditional style are created, and circumcisers are playing important role to indicate the styles to the people. Not only for the girl who take the options but for the parents and husbands it is very new situation, and the options signifies people's position toward their tradition and sometimes utilizes political context. I, thus, examine changing values regarding FC/FGM and their new role in the society.

Paper short abstract:

This presentation focuses on herders' etiology and folk therapies of common illnesses related to state violence in northeastern Uganda. It indicates creative resourcefulness of body in rebuilding worlds and inextricably associated risk of biomedicine to personal and social bodies.

Paper long abstract:

Drawing on ethnographic research conducted in Karamoja, northeastern Uganda, during forcible disarmament policy and state-imposed sedentarization followed by influx in medical aid, this presentation explores roles the bodies play in reflecting the way the patient experience and understand their distress, reconfiguring identity in accordance with the natural social landscape and rebuilding the conflict-destroyed society. For the perpetrators wishing to dominate people, self-identity, everyday lives, and physical body become their targets of violence. Thus it affects the physical and social well-being of people through the destructive forces of bombs, bullets, sticks, and military boots, and through the disruption of subsistence by which to address their health needs, the scarcity of food and the spread of illnesses that embody such disruptions. People understand the local illness related to violence in terms with socially emotional life, which means its contextualization in personal and social bodies. Personnel engaged in clinical care separate such an illness from the context of social turmoil by hypostatizing human nature of violence, and at once place it within the individual body and authorize themselves over "bodily fact" by diagnosing. Understanding local illness related to violence within biomedicine is another kind of violence for those coping with the chronic instability, resisting violence and recourse toward reestablishing their life-worlds is the integral part of healing. Describing how people interpret somatic expressions is crucial in understanding the complex and creative way how they come to term with illness and how it can be coped with.

Paper short abstract:

This study will discuss potential contributions of anthropology to global health. Our ethnographic research of a ethnomedicine in northern Ethiopia indicate that the research findings are fed back upon medical practitioners and have ‘relativizing effect’ on their views about health promotion.

Paper long abstract:

Anthropologists are more or less "useless" in global health. It is a social science that belongs to non-medical sector and does not perform laboratory experiments. Its basic research methods, participant observation and kinds of interviews, are qualitative, which provide data and analysis in non-measurable formulation. Anthropology still makes its low presence in health and medical sector.

​This study attempts to find the ways anthropological approaches contribute to global health projects such as infectious disease control, community health, primary health promotion and maternal health improvement. It will examine the impact of an anthropological research on a disease surveillance project in northern Ethiopia. Two postgraduate students of Nagasaki University are engaged in the research aiming primarily to explore 1) a transitional phase from "traditional" medicine to biomedicine by focusing on folk etiology of "milk-teeth diarrhea", and 2) home birth practices in rural Ethiopia, which are prevalent in spite of worldwide campaigns for facility-based delivery, by carrying out in-depth case studies.

​The results of research are met by mixed responses. On the one hand, qualitative and ethnographic descriptions concerning socio-cultural factors are given secondary importance while statistical and epidemiological data are first. On the other hand, our ethnographic methods, qualitative as well as quantitative, have turned to have relativizing effect upon the view of health promotion of organizers and medical practitioners.

Paper short abstract:

This study is an ethnographic analysis of Beninese migrants living in Makoko, one of the largest slums in Lagos, Nigeria, to explore how they experience and deal with uncertainty in their search for a remedy for malaria.

Paper long abstract:

One of the features of biomedical intervention in contemporary African societies is seemingly to provide healthcare access to even the most marginalized places to cure people from affliction, anxiety and suffering; but it also increases uncertainty in people's everyday lives, which is increasingly experienced in different ways by individuals and communities. This study approaches this latter feature through an ethnographic analysis of the Beninese migrants called Egun living in Makoko, one of the largest slums in Lagos, Nigeria, to explore how they experience and deal with uncertainty in their search for a malaria remedy.

Malaria is perceived among Egun people as a major, inescapable, and "everyday" illness, despite the great efforts of the Ministry of Health and NGOs to promote better healthcare access in Makoko. People are reticent to use medical facilities outside of Makoko because of uncertainty derived from differences in language and ethnicity, and changes in healthcare, medical quality, and personal relationships with medical staff. On the other hand, there has been a greater willingness to use hospitals operated by Egun people inside Makoko, and people have been returning to their hometowns in Benin in search of remedies despite the journeys' great costs in terms of both time and money.

This study suggests that their flow back to their hometowns, which relies on kinship ties, may ensure healthcare access; yet at the same time, it forecloses certain therapeutic choices by maintaining attachment only to hometown medicine, which does not always give people their desired remedy.

Paper short abstract:

This study will look into the practices of both traditional birth attendants and church birth attendants in Lagos and argue that while they have incorporated biomedicine due mainly to the state training programs, they should be considered as entrepreneurs who combine different practices for profits.

Paper long abstract:

In Lagos, the largest city in Nigeria, it looks as though the practices of both traditional birth attendants (TBA) and church birth attendants (CBA) are being integrated into the health delivery policy under the influence of biomedicine. The ministry of health in Lagos state has been providing the practitioners with training courses in which they learn the basics of obstetrics and hygiene and work as intern-nurses at general hospitals. This has led to considerable changes in their practices which may well be described as medicalization. However this does not mean that their overall practices are uniformly giving a way to biomedical paradigm.

The 'medicalization' of TBAs' practices can easily be observed, for instance, in their antenatal clinics where they regularly examine pregnant clients and send them to laboratory tests and their etiology in which they attribute miscarriage mainly to fibroid, Rh-blood type, and repeated abortion. Yet they are proud of using herbal medication for their clients. CBAs also have antenatal clinics and sometimes refer their patients to hospitals. But they employ spiritual healings which include prayer, holy water and fasting.

These hybrid practices are due partly to a market situation where these practitioners must attract clients by stressing the distinctive areas of their specialty as well as incorporating something new and global in order to make profit. In this respect, they are entrepreneurs who try to seize whatever chances they encounter, while maintaining trustworthy practices. Biomedicine appears to form one of such chances for them.