Does medical humanities matter? The challenge of COVID-19.

Medical humanities has tended first and foremost to be associated with the ways in which the arts and humanities help us to understand health. However, this is not the only or necessarily the primary aim of our field. What the COVID-19 pandemic has revealed above all is what the field of critical medical humanities has insisted on: the deep entanglement of social, cultural, historical life with the biomedical. The pandemic has been a time for reinstating the power of expertise of a particular kind, focusing on epidemiology, scientific modelling of potential outcomes and vaccine development. All of this delivered by science at speed.It has been challenging for medical humanities researchers to find purchase in these debates with insights from our more contemplative, 'slow research' approaches. However, as the height of the crisis passes, our field might now be coming into its own. The pandemic, as well as being productive of scientific expertise, also demonstrated clearly the meaning of culture: that it is not a static entity, but is produced and evolves through interaction and relationship. Taking a longer view, we can see the emergence of a certain 'COVID-19 culture' characterised by entanglements between expert knowledge, social media, the economy, educational progress, risk to health services and people in their socio-economic, political ethnic and religious/spiritual contexts. It is the role of medical humanities to pay attention to those interactions and to examine how they play out in the human experience and potential impact of the pandemic. However, to survive and grow in significance within the field of healthcare research, we need to engage not just to comment. There is a need for medical humanities scholars to assert our expertise in interdisciplinary research, fully engaged with experts by experience, and to work proactively with funders to demonstrate our value.

Number worship: Race, place and numbers in 'the San Francisco America pretends does not exist'.

Numerical knowledge is critical to global public health, but numbers often emerge from contexts that require serious attention to historical and contextual factors shaped by race and place-based marginalisations. Without such attention, even progressive anti-racist public health projects can cause harm in neighbourhoods like Bayview Hunters Point in San Francisco. The central role of numbers in governance has received substantial scholarly attention and ethnographic studies often foreground the subjective stakes and selective erasures that result from privileging numerical ways of knowing. Based on 12 months of ethnographic research conducted in 2003-2004, we track different interpretations around the closure of an HIV/AIDS medication adherence program in San Francisco's only majority Black neighbourhood. Drawing on Du Bois' double consciousness, we show the entanglement of numbers, race and place through the story of how a program's closure was interpreted by clients in terms of racialised neglect and experimental violence. Twenty years later, in the context of the COVID-19 pandemic, the quest for numbers continues to evoke community tensions.

Risk, vulnerability, participation

The dialogue between medical anthropology and epidemiology is important in Tullio Seppilli's thought. Indeed, the probabilistic mechanisms of a statistical nature make it possible to identify significant correlations between risk, health, and power structures. Even considering the recent changes in the Covid-19 syndemic, the text outlines an anthropological approach to health aimed at understanding the generative processes of vulnerabilities and inequalities in contemporary societies.Alternate abstract: Il dialogo fra antropologia medica ed epidemiologia è importante nel pensiero di Tullio Seppilli. I meccanismi probabilistici di ordine statistico permettono infatti di individuare significative correlazioni fra rischio, livelli di salute e assetti di potere. Anche in riferimento ai recenti cambiamenti intervenuti con la sindemia Covid-19, nel testo viene delineato un approccio di antropologia della salute volto a comprendere i processi generativi delle vulnerabilità e delle diseguaglianze nelle società contemporanee.

Medical Anthropology at the End of Life

The COVID-19 pandemic has brought critical issues of human mortality to the forefront of medical anthropology. This chapter examines some of the challenges of ethnography at the end of life, the ideals and realities of a "good death” and it's shifting meanings across societies and historical periods, the problems and prospects of living while dying in the context of hospital-based biomedicine, and the hospice and palliative care movements. Autobiographies can serve as informant accounts when the author has the ethnographic sensibilities to at least bring us somewhat nearer to a lived experience. In The Hour of Our Death, Phillippe Aries analyzes popular depictions of death in French literature from the Middle Ages to the early twentieth century. Yet many biomedical structures have historically resisted or constrained such "healing unto death” at the earliest stages of the process: communication about death between patients. The hospice model has undergone some interesting transformations while adapting to non-Western contexts. © 2022 John Wiley and Sons Ltd.

When Workers' Health is Public Health: The Structural Complicity of State Public Health Policies on Covid-19 Spread in Meat-Processing Plants and Minority Communities

The sense of urgency and fear in the early months of the COVID-19 pandemic set the stage for unusual levels of state intervention in civic life, which, in the case of the Trump Administration, tilted heavily toward corporate welfare in the guise of public protection. This chapter draws on insights from such historical and theoretical frameworks to examine the pandemic's impact on US meatpacking workers, including evidence of "structural complicity” by health authorities (and other officials) with the meat industry, which exacerbated viral spread in two southern states. A critical medical anthropology perspective implies attentiveness to roles of power dynamics, economic inequity and racial/ethnic differences in shaping health and disease, and examination of cultural experiences of disease within the context of macrolevel structures and processes. This trend was exacerbated during the COVID-19 pandemic, which represented perhaps the most profound failure of US public health institutions in the country's history. © 2022 John Wiley and Sons Ltd.

'Hawa' and 'resistensiya': local health knowledge and the COVID-19 pandemic in the Philippines.

Understanding people's concepts of illness and health is key to crafting policies and communications campaigns to address a particular medical concern. This paper gathers cultural knowledge on infectious disease causation, prevention, and treatment the Philippines that are particularly relevant for the COVID-19 pandemic, and analyzes their implications for public health. This paper draws from ethnographic work (e.g. participant observation, interviews, conversations, virtual ethnography) carried out individually by each of the two authors from February to September 2020. The data was analyzed in relation to the anthropological literature on local health knowledge in the Philippines. We find that notions of hawa (contagion) and resistensiya (immunity) inform people's views of illness causation as well as their preventive practices - including the use of face masks and 'vitamins' and other pharmaceuticals, as well as the ways in which they negotiate prescriptions of face mask use and physical distancing. These perceptions and practices go beyond biomedical knowledge and are continuously being shaped by people's everyday experiences and circulations of knowledge in traditional and social media. Our study reveals that people's novel practices reflect recurrent, familiar, and long-held concepts - such as the moral undertones of hawa and experimentation inherent in resistensiya. Policies and communications efforts should acknowledge and anticipate how these notions may serve as either barriers or facilitators to participatory care and improved health outcomes.

Death, Funerals and Mourning on the Croatian Islands During the COVID-19 Pandemic

On islands and in island communities, especially smaller and more isolated ones, epidemics were often of greater intensity and left more significant consequences than on the mainland. The unique characteristics of an island (size, remoteness, isolation, small population size, and several manageable access points) affect the transmission of mainland epidemics and their frequency. The current global COVID-19 pandemic is an opportunity to investigate how the infection and epidemiological measures affected the life and death of island communities. The pandemic has brought mass death into our daily lives and altered the way people grieve, commemorate and remember their deceased. This paper presents the experiences and feelings of people during the COVID-19 pandemic on Croatian islands, with a focus on death, funer-als, mourning, and the loss of family members. Due to the impossibility of carrying out the usual practices related to the funeral because of COVID-19 restrictions, the process of mourning and dealing with the loss of loved ones was difficult. Island communities accepted the new rules and adapted to the new circumstances but indicated that island-specific and more flexible crisis management should be applied during this health crisis. Some epidemiological measures, such as social distancing, internal island travel restrictions, and reduced gatherings, were highlighted by islanders as challeng-ing and sometimes unnecessarily strict for some islands and their specific situations. For family members of those who died from COVID-19, additional factors and challenges have complicated their loss. Digital and social media were used to connect people and helped in coping with mourning in solitude and isolation. In this global pandemic, island communities responded to the impact of pandemic crises and adapted to new circumstances of the "new normal”. © 2022, Croatian Anthropological Society. All rights reserved.

Searching for the 'Trigger': An ethnographic analysis of parental beliefs regarding autism causation and vaccination in Puerto Rico.

This study examines the personal beliefs held by parents of autistic children in Puerto Rico regarding the cause of their child's autism and how these beliefs may influence parental vaccination decision-making. This study seeks to contribute towards diversifying the autism literature by focusing on an autism community living in a relatively lower income, resource-deficit context. These findings expand our understandings of how parents of autistic children may perceive vaccines and how these perceptions are informed by various sources of knowledge. This ethnographic research study was conducted between May 2017 and August 2019. Methods included 350+ hours of participant-observation and semi-structured interviewing of 35 Puerto Rican parents of autistic children. 32 of these 35 parents interviewed believed autism to be the result of genetic risks that are 'triggered' by an unknown environmental factor. Suggested 'triggers' included various environmental contaminants and vaccinations. The subject of vaccination came up in every interview; 18 interviewed parents did not believe vaccines 'triggered' autism, 3 parents attributed their child's autism entirely to vaccines, while 14 considered vaccines to be one of several possible 'triggers'. It is important to note that no parents interviewed perceived vaccinations to be inherently or universally harmful. Rather, they perceived vaccinations to be one of many possible 'triggers' for a child predisposed to develop autism. In some cases, this perception prompted parents to oppose mandatory vaccination policies on the island. Parents shared nuanced, complex understandings of autism causation that may carry implications for COVID-19 vaccine uptake within the Puerto Rican autistic community.

Mental Health of Doctors Who Treat Patients with covid-19 in Mexico City: An Anthropological Investigation / La salud mental de los médicos que atienden covid-19 en la Ciudad de México: una investigación antropológica / A saúde mental dos médicos que tratam a covid-19 na Cidade do México: uma investigação antropológica

Introduction: The objective of this article was to explore, from an anthropological perspective, the social representations that doctors who treat covid-19 in specialized hospitals in Mexico City have, regarding the relationship between their professional performance and the deterioration of their mental health; as well as their social representations of the existing institutional resources to provide them mental health attention and their care-seeking and self-care strategies. Materials and Methods: For this, a quali-tative investigation was carried out with semi-structured interviews with 35 doctors who treat covid-19. Results: From the points of view of the doctors, various sociocultural and structural causes of mental illness related to their professional performance are documented and analyzed, as well as their repre-sentations about the inadequacy and/or ineffectiveness of the institution, group, or individual resources to provide them mental health attention; and some allopathic and non-biomedical forms of care-seeking and self-care. Conclusions: Recommendations are made to address the etiologies of the disease analyzed in a culturally and structurally appropriate way to the context of the pandemic.

Introducción: el objetivo de este artículo es explorar, desde una perspectiva antropológica, las representaciones sociales de los médicos que atienden covid-19 en hospitales especializados de la Ciudad de México, respecto a la relación entre su desempeño profesional y el deterioro de su salud mental, así como de los recursos institucionales existentes para atenderla y sus estrategias de búsqueda de atención y de autoatención. Materiales y métodos: para ello, se realizó una investigación cualitativa con entrevistas semiestructuradas a 35 médicos que atienden covid-19. Resultados: a partir de sus puntos de vista se documentan y analizan diversas causas socioculturales y estructurales del padecimiento mental relacionado con su desempeño profesional, así como sus representaciones sobre la inadecuación o ineficacia de los recursos institucionales, grupales o individuales, para atenderlo y algunas modalidades de búsqueda de atención y autoatención alopáticas y no biomédicas. Conclusiones: se realizan recomendaciones para abordar institucionalmente las etiologías del padecimiento reportadas por los entrevistados de una forma cultural y estructuralmente adecuada al contexto de la pandemia.

Introdução: O objetivo deste artigo é explorar, a partir de uma perspectiva antropológica, as represen-tações sociais que os médicos que tratam a covid-19 em hospitais especializados na Cidade do México, têm sobre a relação entre seu desempenho profissional e a deterioração de sua saúde mental; bem como os recursos institucionais existentes para cuidar da saúde mental e as estratégias de busca de cuidado e autocuidado. Materiais e métodos: Para isso, foi realizada uma pesquisa qualitativa com entrevistas semiestruturadas com 35 médicos que tratam da covid-19. Resultados: Do ponto de vista dos médicos, são documentadas e analisadas diversas causas socioculturais e estruturais do adoecimento mental relacio-nadas à sua atuação profissional, bem como suas representações sobre a inadequação e/ou ineficiência dos recursos institucionais, grupais ou individuais, disponíveis para atendê-los e algumas modalidades de busca de cuidado e autocuidado alopáticos e não biomédicos. Conclusões: São feitas recomendações para abordar institucionalmente as etiologias da doença relatadas pelos entrevistados de forma cultural e estruturalmente adequada no contexto da pandemia.

Introduction: Journaling and Mental Health during COVID-19: Insights from the Pandemic Journaling Project.

In this article, we introduce the SSM-MH Special Issue "Journaling and Mental Health during COVID-19: Insights from the Pandemic Journaling Project," which presents findings from the Pandemic Journaling Project (PJP). PJP is an online journaling platform and mixed-methods research study created in May 2020 to provide ordinary people around the world an opportunity to chronicle the impact of the COVID-19 pandemic in their lives-for themselves and for posterity. The essays in this collection demonstrate how journaling via an online platform can help illuminate experiences of mental wellbeing and distress, with important implications for both research and clinical practice. We begin by introducing the Pandemic Journaling Project and describing our procedures for generating the data subsets analyzed in the papers collected here. We then outline the principal interventions of the special issue as a whole, introduce the papers, and identify a number of cross-cutting themes and broader contributions. Finally, we point toward key questions for future research and therapeutic practice by highlighting the three-fold value of online journaling as a research method, a therapeutic strategy, and a tool for advancing social justice. We focus in particular on how this innovative methodological approach holds promise as both a modality for psychotherapeutic intervention and a form of grassroots collaborative ethnography. We suggest that our methods create new opportunities for confronting the impact of pandemics and other large-scale events that generate radical social change and affect population-level mental health.

A New Time of Reckoning, a Time for New Reckoning: Views on Health and Society, Tensions between Medicine and the Social Sciences, and the Process of Medicalization

This article seeks to capture variations and tensions in the relationships between the health–illness–medicine complex and society. It presents several theoretical reconstructions, established theses and arguments are reassessed and criticized, known perspectives are realigned according to a new theorizing narrative, and some new notions are proposed. In the first part, we argue that relations between the medical complex and society are neither formal– nor historically necessary. In the second part, we take the concept of medicalization and the development of medicalization critique as an important example of the difficult coalescence between health and society, but also as an alternative to guide the treatment of these relationships. Returning to the medicalization studies, we suggest a new synthesis, reconceptualizing it as a set of modalities, including medical imperialism. In the third part, we endorse replacing a profession-based approach to medicalization with a knowledge-based approach. However, we argue that such an approach should include varieties of sociological knowledge. In this context, we propose an enlarged knowledge-based orientation for standardizing the relationships between the health–illness–medicine complex and society.

COVID-19 vaccination campaigns and the production of mistrust among Roma and migrant populations in Italy

Achieving high rates of COVID-19 vaccination has become central to a return to normalcy in a post-pandemic world. Accordingly, exceptional measures, such as the regulation of immunity through vaccine passports and restrictions that distinguished between vaccinated and unvaccinated individuals, became a feature of vaccination campaigns in certain G7 countries. Such policies stand in tension with recent supranational European Union policies that seek to build inclusion and trust through engaging minoritised groups in vaccine campaigns. To explore this tension, we present novel ethnographic data produced with migrant and Roma communities in Italy. Our evidence suggests that under restrictive measures, many within these groups initially described as ‘vaccine hesitant’ have accepted a vaccine. Yet, rather than indicating successful civic engagement, we find that vaccine acceptance was tied to deepening mistrust in science and the state. Considering the structural socioeconomic, historical and cultural elements informing people’s vaccination choices, we propose a shift in emphasis towards equitable principles of engagement.

“Early stimulation” in the scenario of Congenital Zika Virus Syndrome: Challenges in three temporalities in the Metropolitan Recife Area, State of Pernambuco

In 2015, the Zika virus epidemic was declared in Brazil. More than 4,000 children were infected and developed what is known as the Congenital Zika Virus Syndrome. Incurable and only palliated with drugs, for the syndrome, “early stimulation” was presented as the only therapeutic possibility. In 2020, a pandemic, Covid-19, arrives in the country, severely disrupting the lives and care of these children and their families in the Recife, State of Pernambuco region. In this article, three times pervaded by these two health emergencies will be described. At the beginning of the Zika epidemic (2016), rehabilitation therapies were being organized, known and demanded by families. In 2019, with the virus cooled down, vacancies for therapy began to dwindle and families were more discerning and critical about them. In the third period (2020), clinics are closed in the name of social isolation and rehabilitation presents new dilemmas for these families. Rehabilitation routines have allowed for an expansion of the public sphere and spaces for dialogue and questioning of the State and its policies aimed at children and both epidemics. Withdrawal from these routines has far wider consequences for the children, their family and the wider community. © 2022, Brazilian Anthropology Association. All rights reserved.

Anthropological Responses to COVID-19 in the Philippines

This article reflects on the roles anthropologists have played in responding to the COVID-19 pandemic in the Philippines, and identifies the challenges - from the methodological to the political - they faced in fulfilling these roles. Drawing on the author's personal and professional experiences in the country, as well as on interviews with other anthropologists, this article identifies three major roles for anthropologists: conducting ethnographic research;bearing witness to the pandemic through first-person accounts;and engaging various publics. All these activities have contributed to a greater recognition of the role of the social sciences in health crises, even as anthropologists struggle to gain the same legitimacy as their clinical and public health counterparts. The article concludes by making recommendations that can better prepare local anthropologists in responding to future health crises.

Addressing COVID-19 vaccination equity for Hispanic/Latino communities by attending to aguantarismo: A Californian US-Mexico border perspective.

With an eye to health equity and community engagement in the context of the initial COVID-19 vaccine roll-out, the COVID-19-related concerns of the Latinx (Hispanic/Latino) community in southern San Diego (California, USA) were examined using 42 rapid, ethnographically-informed interviews and two focus groups conducted in early-mid 2021. An anthropologically oriented qualitative analysis delimited the cultural standpoint summarized as aguantarismo, which celebrates human durability in the face of socioeconomic hardship and the capacity to abide daily life's challenges without complaint. After characterizing aguantarismo, its role in both undermining and supporting vaccine uptake is explored. To avoid diverting attention from the structural factors underlying health inequities, the analysis deploys the theoretical framework of critical medical anthropology, highlighting inequities that gain expression in aguantarismo, and the indifference toward vaccination that it can support. In placing critical medical anthropology into conversation with the cultural values approach to public health, the analysis sheds new light on the diversity of human strategies for coping with infectious disease and uncovers new possibilities for effective vaccination promotion. Findings will be useful to public health experts seeking to convert non-vaccinators and optimize booster and pediatric COVID-19 vaccine communications. They will also contribute to the literature on cultural values in relation to Hispanic/Latino or border health more broadly, both by confirming the vital flexibility of cultural standpoints like aguantarismo and by documenting in situ what is to the social science and health literature, albeit not to cultural participants, a novel constellation.

Perceptions of and hesitancy toward COVID-19 vaccination in older Chinese adults in Hong Kong: a qualitative study.

BACKGROUND: COVID-19 vaccination is recommended for older adults by the World Health Organization. However, by July 15, 2021, only 26% of individuals over 60 years old in Hong Kong had received a first dose of the vaccine. The health belief model and the theory of planned behavior have been used to understand the determinants for COVID-19 vaccination in past literature. However, vaccination determinants can be complex and involve social and cultural factors that cannot be explained by micro-individual factors alone; hence, the health belief model and the theory of planned behavior cannot provide a complete understanding of vaccine hesitancy. Few studies on the barriers to, hesitancy toward, and motivations for COVID-19 vaccination among older Chinese adults have been performed. The aim of this study is to fill this gap by conducting a comprehensive analysis of this subject using the critical medical anthropology framework, extending the health belief model and the theory of planned behavior in understanding vaccination determinants among the older adult population. METHODS: Between November 2020 and February 2021, 31 adults (24 women and 7 men) over the age of 65 took part in semi-structured, one-on-one interviews. The data we gathered were then analyzed through a phenomenological approach. RESULTS: Two major themes in the data were examined: barriers to vaccination and motivations for vaccination. The participants' perceptions of and hesitancy toward vaccination demonstrated a confluence of factors at the individual (trust, confidence, and social support networks), microsocial (stigma toward health care workers), intermediate-social (government), and macrosocial (cultural stereotypes, civic and collective responsibility, and economic considerations) levels according to the critical medical anthropology framework. CONCLUSIONS: The decision to receive a COVID-19 vaccination is a complex consideration for older adults of low socioeconomic status in Hong Kong. Using the critical medical anthropology framework, the decision-making experience is a reflection of the interaction of factors at different layers of social levels. The findings of this study extend the health belief model and the theory of planned behavior regarding the understanding of vaccination perceptions and relevant behaviors in an older adult population.

It's about time: on the need of a temporal language for ecologically dimensioned medical humanities and public health scholarship.

The COVID-19 pandemic has highlighted multiple system dependencies that urge us to rethink our relationship with other humans, non-humans and their various environments. Whereas a growing body of literature highlights the need for ecologically dimensioned medical humanities, focusing on where and how our healths unfold relationally through their ecologies, this paper argues that little attention has been paid to the when of health. In reply, this paper sets out to expand this understanding, first by grounding the ecological argument for medical humanities in a wider net of relational ontologies, and second by highlighting the need to think temporally, specifically multitemporally, about the relationalities of health. The paper advances the sociological concepts of 'time' and 'temporalities' to help us think about various tempi, rhythms, urgencies and legacies of how health unfolds unevenly into the future.

Applied Medical Anthropology and Structurally Informed Emergency Care in the Evolving Context COVID-19

This article describes the integration of medical anthropologists as direct members of health care teams within a large, urban teaching hospital as a means to address the role of structural inequality in unequal health care delivery within the context of COVID-19. The pandemic starkly underlined the role structural forces such as food insecurity, housing instability, and unequal access to health insurance play among vulnerable populations that seek health care, particularly within the emergency department (ED). There is a critical need to recognize the reality that disease acquisition is a cultural process. This is a significant limitation of the biomedical model, which often considers disease as a separate entity from the social contexts in which disease is found. Further, a focus on patient-centered care can open the door for critical, clinically applied, medical anthropologists to team with physicians, merging ethnographic methods with health data and the socially constructed realities of patients' lived experience to build new pathways of care. These pathways may better prepare physicians and health care systems to respond to novel threats like COVID-19, which are rooted in pathophysiological origins but have outcome distributions driven by cultural and structural determinants. To this end, we propose a reconfiguration of dominant biomedical ideologies around disease acquisition and spread by examining our work since 2018, which sees anthropologists embedded both locally and systematically in the creation of anthropologically informed treatment pathways for socially complex disease states like HIV, Hepatitis C, and Opioid Use Disorder (Henderson 2018). Understanding how these socially complex diseases concentrate and interact in populations is a potential opportunity to model solutions for other widespread and complex health care crises, including COVID-19.

Thinking global health from the perspective of anthropology.

COVID-19 has brought about political, economic, cultural, and interspecies problems far from medical areas, which challenges academia to rethink global health. For holism principle, anthropology offers valuable insights into these health issues, including the political economy of inequality, cultural diversity, and cultural adaptations, as well as the study of multispecies ethnography. These perspectives indicate that unequal political and economic systems contribute to health problems when people acknowledge disease and illness mechanisms. Moreover, cultural diversity and cultural adaptation are essential for providing appropriate medical solutions. Lastly, as a research method of studying interspecies relationships, multispecies ethnography promotes one health and planetary health from the ultimate perspective of holism. In conclusion, global health is not only a bio-medical concept but also involves political economy, culture, and multispecies factors, for which anthropology proffers inspiring theories and methods.