Melania Calestani

Inextinguishable Fibres: Demolition and the Vital Materialisms of Asbestos

This paper forwards a performative reading of asbestos in economies of disposal. It argues that materials need to be thought through transformative states, not just stable states, and that materials’ performativity varies according to material states. As a radical intervention in form, demolition is one such transformative state, which disturbs and animates materials. Relatively unconsidered in the academic literature, demolition is argued to be the means to an endless source of surprise in the built environment as well as a singular and multiple practice entailing the dissolution of form, the purposeful reduction and dismantling of large-scale objects, salvage and remediation work, and a host of micropractices, including cutting, tearing, sorting, and separating. The paper illustrates asbestos’ interventions in demolition activities, using as its exemplar the case of ship breaking in the EU. More broadly, the paper works with asbestos to show that material properties are not fixed but processual, relational, and distributed. The paper also flags some key questions for the emergent debate on vital materialisms, highlighting the difficulties materials like asbestos pose for thinking through enchantment and generosity; the importance of thinking a vital materialism through remediation as well as salvage; and the need to extend an ethics founded on generosity to encompass respect, humility, responsibility, and surprise towards those materials that most threaten human life.

Using computer decision support systems in NHS emergency and urgent care: ethnographic study using normalisation process theory

BackgroundInformation and communication technologies (ICTs) are often proposed as ‘technological fixes’ for problems facing healthcare. They promise to deliver services more quickly and cheaply. Yet research on the implementation of ICTs reveals a litany of delays, compromises and failures. Case studies have established that these technologies are difficult to embed in everyday healthcare.MethodsWe undertook an ethnographic comparative analysis of a single computer decision support system in three different settings to understand the implementation and everyday use of this technology which is designed to deal with calls to emergency and urgent care services. We examined the deployment of this technology in an established 999 ambulance call-handling service, a new single point of access for urgent care and an established general practice out-of-hours service. We used Normalization Process Theory as a framework to enable systematic cross-case analysis.ResultsOur data comprise nearly 500 hours of observation, interviews with 64 call-handlers, and stakeholders and documents about the technology and settings. The technology has been implemented and is used distinctively in each setting reflecting important differences between work and contexts. Using Normalisation Process Theory we show how the work (collective action) of implementing the system and maintaining its routine use was enabled by a range of actors who established coherence for the technology, secured buy-in (cognitive participation) and engaged in on-going appraisal and adjustment (reflexive monitoring).ConclusionsHuge effort was expended and continues to be required to implement and keep this technology in use. This innovation must be understood both as a computer technology and as a set of practices related to that technology, kept in place by a network of actors in particular contexts. While technologies can be ‘made to work’ in different settings, successful implementation has been achieved, and will only be maintained, through the efforts of those involved in the specific settings and if the wider context continues to support the coherence, cognitive participation, and reflective monitoring processes that surround this collective action. Implementation is more than simply putting technologies in place – it requires new resources and considerable effort, perhaps on an on-going basis.

Political markets: recycling, economization and marketization

Abstract This paper considers recycling as an economic activity, locating it in debates about economization, marketization and performativity. It argues that recycling is a reflexive intervention in economic activity which extends the boundaries of markets, by internalizing objects formerly externalized as wastes and by attending to the temporal properties of materials. It differentiates between activities based on manufacturing recycled products and the activities of materials recovery linked to commodity markets in secondary materials. By taking the in vivo economic experiment resulting from the UKs Ship Recycling Strategy as its empirical focus, the paper demonstrates how recycling connects to wider debates about experimentation and the constitution of markets, and shows the importance of assaying and assay devices as market devices to the economization of recycling. It further shows that, in materials recovery, measurement is estimation and things are hard to pacify. This makes recycling difficult to stabilize as an economic activity. The consequences are considerable: notably, the possibility of economic failure can threaten to contaminate stabilized (or ‘cold’) forms of politics. The importance of contracts as a means to securing politicized markets in secondary materials recovery is indicated.

Doing the ‘dirty work’ of the green economy: Resource recovery and migrant labour in the EU

Europe has set out its plans to foster a ‘green economy’, focused around recycling, by 2020. This pan-European recycling economy, it is argued, will have the triple virtues of: first, stopping wastes being ‘dumped’ on poor countries; second, reusing them and thus decoupling economic prosperity from demands on global resources; and third, creating a wave of employment in recycling industries. European resource recovery is represented in academic and practitioner literatures as ‘clean and green’. Underpinned by a technical and physical materialism, it highlights the clean-up of Europe’s waste management and the high-tech character of resource recovery. Analysis shows this representation to mask the cultural and physical associations between recycling work and waste work, and thus to obscure that resource recovery is mostly ‘dirty’ work. Through an empirical analysis of three sectors of resource recovery (‘dry recyclables’, textiles and ships) in Northern member states, we show that resource recovery is a new form of dirty work, located in secondary labour markets and reliant on itinerant and migrant labour, often from accession states. We show therefore that, when wastes stay put within the EU, labour moves to process them. At the micro scale of localities and workplaces, the reluctance of local labour to work in this new sector is shown to connect with embodied knowledge of old manufacturing industries and a sense of spatial injustice. Alongside that, the positioning of migrant workers is shown to rely on stereotypical assumptions that create a hierarchy, connecting reputational qualities of labour with the stigmas of different dirty jobs – a hierarchy upon which those workers at the apex can play.

Suma qamaña in Bolivia Indigenous Understandings of Well-being and Their Contribution to a Post-Neoliberal Paradigm

In recent decades there has been increasing interest in academic, governmental, and nongovernmental circles worldwide in developing universal definitions of well-being. Governments have progressively shifted their policies on this concept and are currently engaged in improving the well-being of their populations. Bolivia’s concept of suma qamaña (living well together) is broader than “well-being,” emphasizing the importance of harmonious relations between nature and human beings and providing an important link to sustainability that current conceptions of well-being fail to make. Exploring the concept is highly relevant at this historical moment because the Morales government is engaged in a wide-ranging process of social transformation to implement it. Its translation into public policy and the adoption of a development model consistent with it have proved problematic. While the introduction of the concept into the National Development Plan, the new constitution, and the Law of Mother Earth has addressed the need to move from individualized understandings of well-being to collective ones, the government has not overcome the conflict between growth-driven approaches and sustainability that is inherent in all its legislation. Moreover, understandings of the concept are constantly being negotiated and transformed, calling for an understanding of it that is rooted in people’s practices and beliefs rather than in theoretical constructions. En las últimas décadas ha habido un creciente interés en los círculos académicos, gubernamentales y no gubernamentales de todo el mundo en el desarrollo de las definiciones universales de bienestar. Los gobiernos han cambiado progresivamente sus políticas en este concepto y se dedican actualmente a la mejora del bienestar de sus poblaciones. Concepto de suma qamaña (vivir bien) de Bolivia es más amplio que el “bienestar,” enfatizando la importancia de las relaciones armoniosas entre la naturaleza y los seres humanos y proporcionando un vínculo importante con la sostenibilidad que las concepciones actuales de bienestar no pueden hacer. Explorar el concepto es muy relevante en este momento histórico, porque el gobierno de Morales está involucrado en un amplio proceso de transformación social para implementarla. Su traslación en las políticas públicas y la adopción de un modelo de desarrollo coherente con ella han demostrado ser problemático. Si bien la introducción de este concepto en el Plan Nacional de Desarrollo, la nueva Constitución, y la Ley de la Madre Tierra ha abordado la necesidad de pasar de entendimientos individuales de bienestar a los colectivos, el gobierno no ha superado el conflicto entre los enfoques impulsados por crecimiento y la sostenibilidad que es inherente a toda su legislación. Por otra parte, las comprensiones del concepto están siendo constantemente negociados y transformados, reclamando una comprensión que está enraizada en las prácticas y creencias de las personas y no en las construcciones teóricas.

Being ‘an authentic alteño’: young people in a Bolivian Andean city

What does it mean to be young in El Alto, a Bolivian shantytown? Based on ethnographic research, this article looks at cultural resilience among young people in a vulnerable urban context. It emphasises how young people value informal youth groups as a tool to valorise their own indigenous culture. This is echoed in the world of adults, implying that the collective is a value shared by all. By giving an insight into everyday life in El Alto, the article aims to shed light on issues of identity among second generation migrants, looking at the experiences of rural-urban migrants’ children within Bolivia. The article begins by setting the scene and providing information on young people in El Alto. Later, the article focuses on one of the informal youth groups in the city, looking at the importance of dancing and music for their collective identity. This article is about youth and how they negotiate their rural-urban identity as children of rural-urban indigenous migrants. As my young informants often say, the model offered by their parents is described as ‘good’ and ‘morally rich’, while the one offered by the city is ‘bad’ and ‘amoral’. However, there is a tension. If they decide to follow the model of their parents, they will be excluded and discriminated against in the national context. By exploring the political-economic contexts in which youth are growing up in El Alto, the article sheds light on the long-term effects of migration, indigenous and urban identities and cultural resilience in an Andean indigenous city.

Vivir bien, entre utopía y realidad

Resumen es: Los paradigmas dominantes del bienestar siguen empenandose en entender lo que este termino significa. De igual manera, los disenadores de politicas publi...

Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study

Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives. Objectives What is the impact of the adapted Buurtzorg model on feasibility, acceptability and effective outcomes in an English district nursing service? Design Mixed methods case study. Setting Primary care. Participants Neighbourhood nursing team (Buurtzorg model), patients and carers, general practitioners (GPs), other health professionals, managers and conventional district nurses. Results The adapted Buurtzorg model of community nursing demonstrated feasibility and acceptability to patients, carers, GPs and other health professionals. For many patients, it was preferable to previous experiences of district nursing in terms of continuity in care, improved support of multiple long-term conditions (encompassing physical, mental and social factors) and proactive care. For the neighbourhood nurses, the ability to make operational and clinical decisions at team level meant adopting practices that made the service more responsive, accessible and efficient and offered a more attractive working environment. Challenges were reported by nurses and managers in relation to the recognition and support of the concept of self-managing teams within a large bureaucratic healthcare organisation. While there were some reports of clinical effectiveness and efficiency, this was not possible to quantify, cost or compare with the standard district nursing service. Conclusions The adapted Buurtzorg model of neighbourhood nursing holds potential for addressing issues of concern to patients, carers and staff in the community. The two interacting innovations, that is, a renewed focus on patient and carer-centred care and the self-managing team, were implemented in ways that patients, carers, other health professionals and nurses could identify difference for both the nursing care and also the nurses’ working lives. It now requires longer term investigation to understand both the mechanism for change and also the sustainability.

Variation in Practice Patterns for Listing Patients for Renal Transplantation in the United Kingdom: a National Survey.

Background Despite the availability of guidelines for the evaluation of candidates for renal transplantation, variation in access to transplantation exists. This national survey investigates whether center variation exists in the assessment of patients for renal transplantation in the United Kingdom. Methods An online survey, informed by qualitative interviews, was distributed to all UK renal centers. This survey examined center approaches to chronic kidney disease service provision, transplant recipient assessment, education provision, and waitlisting decision making processes. Center reevaluation policies for patients already listed and priorities for future development were also examined. Results All 71 renal centers responded. Of these, 83% reviewed predialysis patients in a low clearance clinic. In 26% of the centers, transplantation was not discussed as a treatment option with all patients. Fourteen centers reported having a dedicated transplant assessment clinic, whereas 28% did not have a formal assessment protocol. Age was an exclusion criterion for listing in 3 centers, all of which had a cutoff at 75 years. Eighty-three percent of the centers excluded patients with a high body mass index. Cardiac investigations were risk-stratified in 90% of centers. Surgical involvement varied with 11% of centers listing patients without formal surgical review. There was no formal protocol in place to reevaluate listed patients in 62% of centers. Conclusions There is wide variation in UK practice patterns for listing patients for renal transplantation, though its impact on access to transplantation is unclear. The extent to which center-specific and patient-specific factors affect access to transplantation requires further analysis in a prospective cohort of patients.

Well-Being and Community

This chapter looks at how my ethnographic research questions the very validity of a general, abstract concept of well-being, showing the importance of taking into account local criteria and trying to overcome the often reproduced fracture between theoretical models and everyday life, between the factual and the possible. The point of departure for my critique is the analysis of how a group of Aymara intellectuals has imagined, built and represented ‘a collective indigenous theory of well-being’. Their ideology of well-being finds its origins in an idealised (and rural) past in opposition to the ill-being of the present (urban) way of life. I argue that their representation appears frozen in time and space, and offers a static definition of ‘the good life’. This echoes similar definitions and models proposed by development economics. Moreover, this chapter focuses on the issue of community values, and the tensions between these and individual desires and ambitions, which are important topics in the overall book. The discussion of models allows me to show the complexity of issues emerging when engaging with well-being and everyday life: issues of temporality and space are also fundamental to shed light on definition of well-being as well as on collective and individual identity.