Frédéric Le Marcis

The Suffering Body of the City

S ince 1990, parallel to the period of transition to a democratic society, the AIDS epidemic in South Africa has increased dramatically. The level of HIV infection in the adult population (ages 15–49) rose from 1 percent in 1990 to more than 20 percent in 2000. However, this figure conceals a disparity in the distribution of the disease. The townships are affected far more than the largely white suburbs, while in the townships themselves the highest levels are found in the so-called squatter camps (Shisana and Simbayi 2002).1 The combination of pandemic and democracy has wrought changes specific to sufferers living on the periphery of Johannesburg. People obtained their freedom and fell sick at the same time. The newly acquired sovereignty has enabled individuals to explore previously unavailable urban spaces, to develop innovative forms of political mobilization, and to access, in new ways, health services that had once

Negotiating care: patient tactics at an urban South African hospital

Objectives: To examine the various ways in which patients sought to influence the care they received in the admission and adult medical services of a large urban, academic hospital in South Africa. These included the steps taken by patients to increase their access to services and improve their experience of care. Methods: Part of a qualitative study of rationing behaviour, the methods combined, observations, interviews and a survey. Results: Patients actions were oriented to two main goals: obtaining care and preserving their sense of self and dignity. These actions shaped patients’ pathways in five key ways: meeting the entry criteria for admission; presenting as a cooperative, expert patient; mobilizing social networks among health care staff; making use of complaints mechanisms; and deploying narratives of resistance. Conclusions: Patients made tactical use of small spaces at the margins of the health care system. Although, with some exceptions, they had limited impact on the care received in the hospital, they highlight patients as active players and point to the ways in which patient agency can be strengthened in the light of the shift towards chronic disease care and greater patient involvement in care.

Life & Times of Magda A Telling a Story of Violence in South Africa

How to write about violence? Most recent anthropological works have dealt with this question in terms of either political economy, narratives, or performance. Using J. M. Coetzees Life & Times of Michael K as a pre‐text, an ethnological inquiry into violence is proposed through the biography of a young South African woman. The reconstitution of her life story through informal interactions and in‐depth interviews embedded in long‐term research in her home community attempts to inscribe her life in its times, in other words, to articulate an experience of extreme poverty and sexual abuse and later of living with HIV and becoming involved in AIDS activism with the historical condition of apartheid and its aftermath. Taking seriously the young womans perspective on her biography implies both epistemological and ethical issues. As it unfolds through her narrative, relocated in its social context, her story can be read as the progressive appropriation of an imposed fate, the slow shift from subordination to subjectification and, finally, a form of political education to violence.

What’s in a Context? Tenses and Tensions in Evidence-Based Medicine

Sackett and colleagues (1996:71) originally defined evidence-based medicine (EBM) as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of i...

Life promises and 'failed' family ties: expectations and disappointment within a clinical trial (Ivory Coast).

Building on fieldwork carried out in a clinical trial looking at early antiretroviral treatment for HIV in Abidjan, this paper aims to analyse the way relations emerge during trials and the consequences of the end of participation. Instead of discussing it using the register of ethics, understood as a universal set of principles, the trial is analysed for what it means locally for its actors, mainly patients. From this standpoint, the trial can be defined as both a promise of life and of new possibilities embodied in what is often described as new family ties. How are such ties formed and what does it mean when these ties are broken at the end of patient participation? Discussing the failure of family ties commented upon by patients and dealt by physician researcher is a way to look at ethics from below.

Vaccination and blood sampling acceptability during Ramadan fasting month: A cross-sectional study in Conakry, Guinea

INTRODUCTION There are few data on the acceptability of vaccination or blood sampling during Ramadan fasting month in Muslim countries. This could impact vaccination campaigns, clinical trials or healthcare during Ramadan. METHODS Using a semi-structured questionnaire, we conducted a cross-sectional study on 201 practising Muslims and 10 religious leaders in Conakry, Guinea in the wake of the recent epidemic Ebola epidemic. Acceptability of vaccination and blood sampling during Ramadan were investigated as well as reasons for refusal. RESULTS Vaccination was judged acceptable during Ramadan by 46% (93/201, 95% CI 0.40-0.53) of practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) of religious leaders (p=0.11). Blood sampling was judged acceptable during Ramadan by 54% (108/201, 95% CI 0.47-0.60) of practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) of religious leaders (p=0.19). The percentage of participants that judged both blood sampling and vaccination acceptable during Ramadan was 40% (81/201, 95% CI 0.34-0.47) for practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) for religious leaders (p=0.048). The most common reasons for refusal of vaccination or blood sampling were that nothing should enter or leave the body during Ramadan (43%), that adverse events could lead to breaking the fast (32%), that blood should not be seen during Ramadan (9%) and that the Quran explicitly forbids it (9%). DISCUSSION Although most Muslims leaders and scientists consider that injections including immunization and blood sampling should be authorized during Ramadan, many Muslims in our study judged vaccination or blood sampling unacceptable when fasting. Widely available recommendations on healthcare during Ramadan would be useful to inform Muslims.

A impossível governança da saúde em prisão? Reflexões a partir da MACA (Costa do Marfim)

Resumo Quem governa a saude nas prisoes? Propomos responder a esta questao a partir de um inquerito etnografico de longaduracao realizado na MACA, a Maison d´Arretet de Correction d´Abidjan (Costa do Marfim). A analise da governanca da saude, na pratica, nao pode ser feita sem uma contextualizacao historica da prisao na sociedade da Costa do Marfim, nem de uma analise da legitimidade atual da prisao e dos presos como objetos de politicas especificas nesse pais. E a luz desse duplo contexto que deve ser analisada a dupla governanca da prisao que rege a vida na MACA e sustenta os valores atribuidos a saude nesse espaco. Um estudo de caso sobre a substituicao de um detento que exercia a funcao de chefe do predio da enfermaria (chef de bâtiment de l’infirmerie) permitira ilustrar como o reconhecimento desta forma de vida singular e uma condicao necessaria para uma intervencao eficaz no campo da saude na prisao.Quem governa a saude nas prisoes? Propomos responder a esta questao a partir de um inquerito etnografico de longaduracao realizado na MACA, a Maison d´Arretet de Correction d´Abidjan (Costa do Marfim). A analise da governanca da saude, na pratica, nao pode ser feita sem uma contextualizacao historica da prisao na sociedade da Costa do Marfim, nem de uma analise da legitimidade atual da prisao e dos presos como objetos de politicas especificas nesse pais. E a luz desse duplo contexto que deve ser analisada a dupla governanca da prisao que rege a vida na MACA e sustenta os valores atribuidos a saude nesse espaco. Um estudo de caso sobre a substituicao de um detento que exercia a funcao de chefe do predio da enfermaria (chef de bâtiment de l’infirmerie) permitira ilustrar como o reconhecimento desta forma de vida singular e uma condicao necessaria para uma intervencao eficaz no campo da saude na prisao.

Prepared for the 'unexpected'? Lessons from the 2014-2016 Ebola epidemic in West Africa on integrating emergent theory designs into outbreak response.

### Summary box How prepared were we for this most recent Ebola outbreak? Real-time emergent research is imperative for successful response to global health emergencies. While innovative biomedical interventions are certainly important,1 local on-the-ground realities during the 2014–2015 West African Ebola epidemic demanded a different though complementary set of research skills. Effective response required deep, sensitive understandings of emergent local dynamics and flexible, emergent solution. Emergency intervention called for evolving, flexible emergent methods that produced and translated rapid knowledge throughout the crisis. Yet, the need for emergent theory methodologies such as ethnography that actively witness and document the unforeseen consequences of emergencies and their response receives little attention in preparedness strategies.2 Global health community preparedness and response largely hinges on the rapid financialisation and development of innovative …

Politiques de lutte contre le paludisme en Casamance, Sénégal: une activité de santé publique soumise aux contextes de conflit et de décentralisation

Cet article analyse, à partir d’une ethnographie menée à Oussouye (Casamance), la manière dont s’incarnent et se traduisent les politiques nationales sanitaires, dans des contextes locaux spécifiques. Il discute des contraintes que rencontre une politique globalisante, ou plus exactement des points aveugles de cette politique pas suffisamment à l’écoute du contexte, c’est-à-dire, des spécificités régionales et géopolitiques. Les résultats indiquent que le contexte de la décentralisation et du conflit casamançais ont eu des effets sur le financement, la gestion des activités promotionnelles et la domestication des recommandations officielles de la lutte contre le paludisme. Par ailleurs, celles antérieures laissent des traces, qui s’expriment dans les discours des acteurs et structurent la façon dont ils pensent la lutte aujourd’hui, alors même que cette dernière est supposée s’inscrire dans un autre paradigme. Enfin la dissonance de la prescription d’antipaludiques à Mlomp et Elinkine fait penser à l’existence de « territoires » locaux de la santé où les recommandations nationales cèdent la place aux spécificités contextuelles et locales. Les politiques de santé ne peuvent faire l’économie ni des acteurs, ni des contextes locaux, cependant la prise en compte de la spécificité ne doit certainement pas se faire au détriment d’une certaine notion de « l’être ensemble ».