Animal sacrifice can be productively theorized as a practice of kindred intimacy between human and nonhuman animal. Drawing on ethnographic fieldwork in India’s Central Himalayas, I trace how the ritual sacrifice of goats in the region’s mountain villages acquires power and meaning through its anchoring in a realm of interspecies kinship. This kinship between humans and animals is created and sustained through everyday practices of intercorporeal engagement and care. I contend, in fact, that animal sacrifice is itself constitutive of interspecies kin relations. The spectacular act of violence at the heart of sacrifice—the beheading of the sacrificial animal—is crucial to the constitution of kin solidarity between human sacrificer and animal victim. From this perspective, animal sacrifice creates a world rich with the possibility of mutual response and recognition between different beings entangled in intimate and complex ways.
Format: Journal
The Politics of Reproduction
The topic of human reproduction encompasses events throughout the human and especially female life-cycle as well as ideas and practices surrounding fertility, birth, and child care. Most of the scholarship on the subject, up through the 1960s, was based on cross-cultural surveys focused on the beliefs, norms, and values surrounding reproductive behaviors. Multiple methodologies and subspecialties, and fields like social history, human biology, and demography were utilized for the analysis. The concept of the politics of reproduction synthesizes local and global perspectives. The themes investigated include: the concept of reproduction, population control, and the internationalization of state and market interests (new reproductive technologies); social movements and contested domains; medicalization and its discontents; fertility and its control; adolescence and teen pregnancy; birth; birth attendants; the construction of infancy and the politics of child survival; rethinking the demographic transition; networks of nurturance; and meanings of menopause. The medicalization of reproduction is a central issue of studies of birth, midwifery, infertility, and reproductive technologies. Scholars have also analyzed different parts of the female life-cycle as medical problems. Other issues worth analysis include the internationalization of adoption and child care workers; the crisis of infertility of low-income and minority women who are not candidates for expensive reproductive technologies; the concerns of women at high risk for HIV whose cultural status depends on their fertility; questions of reproduction concerning, lesbians and gay men (artificial insemination and discrimination in child rearing); the study of menopause; and fatherhood. New discourse analysis is used to analyze state eugenic policies; conflicts over Western neocolonial influences in which women’s status as childbearers represent nationalist interests; fundamentalist attacks on abortion rights; and the AIDS crisis.
Science as Culture, Cultures of Science
Although controversial, science studies has emerged in the 1990s as a significant culture area within anthropology. Various histories inform the cultural analysis of science, both outside and within anthropology. A shift from the study of gender to the study of science, the influence of postcolonial critiques of the discipline, and the impact of cultural studies are discussed in terms of their influence upon the cultural analysis of science. New ethnographic methods, the question of “ethnosciences” and multiculturalism, and the implosion of informatics and biomedicine all comprise fields of recent scholarship in the anthropology of science. Debates over modernism and postmodernism, globalization and environment, and the status of the natural inform many of these discussions. The work of Escobar, Hess, Haraway, Martin, Rabinow, Rapp, and Strathern are used to highlight new directions within anthropology concerning both cultures of science and science as culture.
Emergent forms of life
Anthropologies of late modernity (also called postmodernity, postindustrial society, knowledge society, or information society) provide a number of stimulating challenges for all levels of social, cultural, and psychological theory, as well as for ethnographic and other genres of anthropological writing. Three key overlapping arenas of attention are the centrality of science and technology; decolonization, postcolonialism, and the reconstruction of societies after social trauma; and the role of the new electronic and visual media. The most important challenges of contemporary ethnographic practice include more than merely (a) the techniques of multilocale or multisited ethnography for strategically accessing different points in broadly spread processes, (b) the techniques of multivocal or multiaudience-addressed texts for mapping and acknowledging with greater precision the situatedness of knowledge, (c) the reworking of traditional notions of comparative work for a world that is increasingly aware of difference, and (d) acknowledging that anthropological representations are interventions within a stream of representations, mediations, and unequally inflected discourses competing for hegemonic control. Of equal importance are the challenges of juxtaposing, complementing, or supplementing other genres of writing, working with historians, literary theorists, media critics, novelists, investigative or in-depth journalists, writers of insider accounts (e.g. autobiographers, scientists writing for the public), photographers and film makers, and others.
Pharmaceutical Citizenship
Among practitioners of biomedicine, to speak of people as ‘marginalized’ often amounts to saying that they do not have access to medical substances. Thus conceived, the best way to remove marginality seems to be to give medicines to those deprived of them. The peculiar relationship between marginality and pharmaceuticals is especially poignant in the case of antidepressant drugs, as these drugs appear to bring the patient ‘back into society’, but not any society, but middle-class consumer society. What is now special about antidepressants is that there is nothing special about them: antidepressants are like consumer items among thousands of other consumer items. This paper explores the relations between medicines and marginality with reference to the marketing of antidepressant drugs in Kolkata (Calcutta), India. Drawing on ethnographic fieldwork in the Kolkata metropolitan area from July 1999 to December 2000 and in August/September 2003, this paper examines how people with depression are constituted as ‘marginal’ in the sense of ‘being deprived of medication’, and how the biomedical promise of an effective pharmacological treatment becomes a promise of ‘pharmaceutical citizenship’. In view of Bengali notions of mental health as a state of detachment, the paper asks if pharmacological demarginalization holds the same promise in the Indian context that it holds in the West.
Anthropology’s Contribution to AMR Control
Anthropological study can provide important insights for addressing AMR. This paper describes anthropological approaches for understanding the context of increasing antimicrobial use around the globe as well as how important anthropological contributions to the study of infectious diseases can inform studies of AMR emergence and transmission. Four themes are followed to illustrate this: care; pharmaceuticals and markets; knowledge; and ecologies. Together, these accounts illustrate the complex stories behind our relations with microbes and antimicrobial medicines across the world today, and help us to study and anticipate consequences – intended or not – of both AMR and AMR control strategies globally.
As a clinician, you are not managing lab results, you are managing the patient
In response to widespread overuse of antimalarial drugs, the World Health Organisation changed guidelines in 2010 to restrict the use of antimalarials to parasitologically confirmed malaria cases. Malaria rapid diagnostic tests (RDTs) have been presented as a means to realize the new guidelines, and National Malaria Control Programmes, including that of Cameroon, are developing plans to introduce the tests to replace microscopy or clinical diagnosis at public health facilities across the country. We aimed to understand how malaria tests and antimalarial drugs are currently used as part of social interactions between health workers and patients at public and mission health facilities in Yaoundé and Bamenda and surrounding districts in the Northwest region of Cameroon. In May to June 2010, we held 17 focus group discussions with 146 health workers involved in clinical care from 49 health facilities. Clinicians enacted malaria as a ‘juggling’ exercise, involving attention to pathophysiology of the patient as well as their desires and medical reputations, utilising tests and medicines for their therapeutic effects as symbols in the process of care. Parasites were rarely mentioned in describing diagnostic decisions. These enactments of malaria contrast with evidence-based guidelines emanating from WHO, which assume the parasite is the central driver of practice. If RDTs are to be taken up in practice, public health practitioners need to pay careful attention to the values and priorities of health workers and patients if they are to work with them to improve diagnosis and treatment of febrile illnesses.
Introducing malaria rapid diagnostic tests at registered drug shops in Uganda
In Uganda, around two thirds of medicines are procured from the private sector, mostly from drug shops. The introduction of malaria rapid diagnostic tests (RDTs) at drug shops therefore has the potential to make a significant contribution to targeting antimalarial drugs to those with malaria parasites. We undertook formative research in a district in Uganda in preparation for a randomised trial of RDTs in drug shops. In May to July 2009, we interviewed 9 drug shop workers, 5 health workers and 4 district health officials and carried out 10 focus group discussions with a total of 75 community members to investigate the role of drug shops and the potential for implementation of RDTs at these health care outlets.
Drug shops were seen to provide an important service to community members, the nature of which is determined by responsiveness to client demands. However, drug shops hold a liminal status: in the eyes of different actors, these outlets are at once a shop and clinic; legitimate and illegitimate; and trusted and distrusted. Malaria treatment was found to be synonymous with diagnosis. Diagnostic testing was deemed useful in theory, and community members were curious about the results, with the expectation that a test would decrease uncertainty and help secure an end to illness. However, whether testing would be sought as a routine step in treatment decisions in practice is uncertain, since the appeal of the tests waned in light of their costs and potential for results to conflict with presumed diagnosis.
Interventions that increase awareness of multiple causes and management of malaria-like illness will be needed to support the new rationalisation for malaria treatment represented by parasitological diagnosis.
Guidelines and Mindlines
Why is malaria over-diagnosed despite access to simple diagnostic testing? Why does clinician knowledge not translate into practice? In this ethnographic study of two hospitals in Tanzania, Clare Chandler and her colleagues demonstrated that many non-clinical factors influence malaria diagnosis and treatment. Diagnosing non-malaria febrile illness is complicated, not because of a lack of access to diagnostic tools, or from a lack of clinician knowledge, but because of prevailing social spheres of influence. These social spheres have contributed to the development of clinician ‘mindlines’ that tend to inform diagnosis more than official ‘guidelines’. ‘Mindlines’ can best be understood as constructed rationales for clinician behaviour, that are “collectively reinforced” and act as “internalized tacit guidelines” (Gabbay and le May 2004: 1015) that outweigh impact on practice over official guidelines. Clinician practice is heavily influenced by social concerns and constraints, not by lack of knowledge or lack of appropriate diagnostic tools.
Four social spheres of influence were identified: First, malaria is seen as a safe and easy diagnoses to make in an environment with multiples constraints, and initial clinician training strongly promotes attention to malaria. This training, coupled with a policy environment that portrays malaria widely endemic, have led to the shared belief that to miss a malaria diagnosis is an ‘indefensible’ act. Second, the influence of peers strongly shaped diagnosis practices. Physicians understood malaria as easily recognizable, and misdiagnosing malaria was considered a potential source of humiliation. Third, malaria was perceived by clinicians as an ‘acceptable’ diagnosis for patients. Clinicians described feeling ‘pressure’ from patients for both a malaria diagnosis and for prescribing antimalarial medication. Fourth, quality of diagnostic support (resource management, motivation and supervision) were limited. Clinicians reported trusting their diagnostic skills over formal diagnostic testing, and resisted the idea that antimalarial drugs should only be prescribed in test-positive cases.
Works cited:
Gabbay, J. and A. le May. 2004. Evidence based guidelines or collectively constructed ‘mindlines?’ Ethnographic study of knowledge management in primary care. BMJ, 329(7473):1013.
Antibiotics: The Epitome of A Wonder Drug
Antibiotics can truly be considered the epitome of the 20th century’s “wonder drugs.” This term was widely used in the 1950s, even in official documents, expressing the enthusiasm of patients, doctors, and policy makers for drugs that transformed once mortally feared bacterial infections into curable conditions.
Penicillin is the iconic antibiotic. Its introduction into clinical practice was widely celebrated and was the culmination of individual achievements, long running trends in science, and a supportive environment. In 1929 Alexander Fleming, at St Mary’s Hospital Medical School in London, reported his observation that the culture medium on which a penicillium mould had grown attacked certain bacteria. However, chemists and bacteriologists, then working largely separately, failed to isolate the active substance in the mould juice. Only in 1940 was the isolation achieved, at Oxford, where Howard Florey had created a multidisciplinary team. The team’s efforts were sustained by the interest and talent of, among others, Ernst Chain, a German refugee, and Norman Heatley, who developed key techniques for growing the mould and isolating the drug. But the financial support of the Rockefeller Foundation in the United States and the Medical Research Council in the United Kingdom was also crucial, as were the need created by the outbreak of war and the remarkable properties of penicillin itself. This confluence of factors led rapidly to laboratory scale production and the demonstration of penicillin’s clinical potential.
