Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico.

Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people's uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.

Emotional distress and self-care during the COVID-19 pandemic in women from an indigenous migrant cultural collective in Mexico City / Malestares emocionales y su autoatención durante la pandemia de COVID-19 en mujeres de un colectivo cultural indígena migrante residente en la Ciudad de México

Abstract Introduction During the coronavirus (SARS-Cov-2) pandemic, restrictive measures were implemented to reduce contagion. However, severely decreasing social interaction also negatively impacted the economy, particularly that of indigenous groups. Objective This article seeks to understand the emotional distress identified by a group of indigenous women residents, as well as their self-care practices, during the COVID-19 pandemic in Mexico City. Method A digital qualitative study was undertaken since the fieldwork was conducted in person and online, using various Internet platforms, which served as a field scenario, data collection tool and a means of continuous connection with subjects. Results Anecdotal records were obtained from the subjects, who identified categorizations in the collective organization of the indigenous group, which became a support network for mobilizing official material resources. Information was also obtained on the way the women engaged in the self-care of their emotional distress in a range of ways with a sense of immediacy, through physical, spiritual, herbal, and psychological resources. They observed how women managed to cope with their situation and continue caring for and supporting their families to enable them to get by, distinguishing between those who were providers and those who were dependent on another provider. Discussion and conclusion The pandemic, together with social restrictions, created stressful situations, causing various emotional problems among the indigenous collective. Nevertheless, their capacity for self-management and self-care enabled them to cope with these conditions in the midst of structural contexts of violence, poverty, and social exclusion.

Resumen Introducción Durante la pandemia del nuevo coronavirus (SARS-Cov-2) se instauraron diferentes medidas restrictivas con la finalidad de disminuir los contagios. Sin embargo, al reducir severamente las interacciones sociales también se produjo un impacto negativo en la economía, especialmente en los grupos indígenas. Objetivo Este artículo busca conocer los malestares emocionales identificados por un colectivo de mujeres indígenas residentes, así como sus prácticas de auto-atención, durante la pandemia por COVID-19 en la CDMX. Método Se desarrolló una investigación cualitativa digital ya que el trabajo de campo fue presencial y en línea, así como en diferentes plataformas de la red de internet, las cuales fungieron como escenario de campo, herramienta de recopilación de datos y un dispositivo de conexión constante con los informantes Resultados Se obtuvieron registros anecdóticos de las participantes, que identificaron: categorizaciones en la organización colectiva del grupo indígena, convirtiéndose en red de apoyo que movilizó recursos materiales oficiales; cómo las mujeres practicaron la auto-atención de sus malestares emocionales de manera variada y con un sentido de inmediatez, mediante recursos físicos, espirituales, herbolarios, psicológicos y el saber aguantarse para sobrellevar su situación, y continuar cuidando y apoyando a sus familias a salir adelante, diferenciando entre mujeres proveedoras y las dependientes de otro proveedor. Discusión y conclusión La pandemia junto con las restricciones sociales, generaron situaciones estresantes, desencadenando diversas problemáticas emocionales en el colectivo indígena, pero su capacidad de autogestión y autocuidado les permitió sobrellevar tales condiciones en medio de contextos estructurales de violencia, pobreza y exclusión social.

Total pain and social suffering: marginalised Greenlanders' end-of-life in Denmark.

With a focus on socially marginalised Greenlanders in Denmark, this study explores the significance of the concept of social suffering for the concept of total pain. Greenland is a former Danish colony and Greenlanders retain the right to Danish citizenship with all the benefits of access to the resources of Denmark as any other Danish citizen. However, Greenlanders are overrepresented amongst the most socially disadvantaged in Denmark. They have a disproportionately high risk of early death, often undiagnosed and untreated. This study reports on research conducted with socially marginalised Greenlanders and some of the professionals who work with them. It interrogates the concept of total pain as developed by Cicely Saunders, the founder of modern palliative care. Saunders noted that pain at the end-of-life was not adequately explained by symptoms of a disease process because it was more like a situation that engulfed every aspect of the patient and those close to them; it included physical, psychological, spiritual, and social dimensions. We agree with other scholars that the social dimension of the total pain experience is underexplored. By drawing on the theoretical and methodological lens of intersectionality, our work with marginalised Greenlanders has enabled us to describe the multiple and intersecting social forces that create social suffering for this group. This leads us to conclude that social suffering is not entirely an individual experience but a product of social harm and disadvantage, poverty, inequality, and the various legacies of colonialism, which combine to place some citizens in a harmed condition. Our findings also draw us into a discussion with the concept of total pain and its neglect of the socially constructed nature of social suffering. We conclude by indicating ways in which the concept of total pain can be informed by a more thoroughgoing concept of social suffering. We conclude, with others, that there is a problem of inequity in the way that end-of-life care is currently distributed. Finally, we point to ways in which an understanding of social suffering can help to address the exclusion of some of the most vulnerable citizens from appropriate end-of-life care.

Transgenerational trauma and collective resilience: A qualitative analysis of the experiences of settler-colonial violence among three generations of Palestinian refugees.

BACKGROUND: Palestinian people have endured collective dispossession and social suffering for 74 years from the so-called Al-Nakba (Palestinian catastrophe). AIMS: The present exploratory work sought to analyze experiences of settler-colonial violence over three generations of Palestinian refugees. METHODS: Forty-five participants (Mage = 44.45; range 13-85) were recruited via snowball sampling and interviewed to explore their understanding of transgenerational and collective trauma. Interviews were analyzed through thematic content analysis, resulting in four emerging themes distributed among the three generations. RESULTS: The four themes encompassed (1) The impact of Al-Nakba, (2) Hardships, challenges, and quality of life, (3) Coping strategies, and (4) Dreams and hopes for the future. The results have been discussed using local idioms of distress and resilience. CONCLUSIONS: The Palestinian experience of transgenerational trauma and resilience depicts a portrait of extreme trauma and endurance that cannot be reduced to the mere nosographic collection of Western-informed psychiatric symptoms. Instead, a human rights approach to Palestinian social suffering is most recommended.

Social Suffering: Indigenous Peoples' Experiences of Accessing Mental Health and Substance Use Services.

In this paper, we present findings from a qualitative study that explored Indigenous people's experiences of mental health and addictions care in the context of an inner-city area in Western Canada. Using an ethnographic design, a total of 39 clients accessing 5 community-based mental health care agencies were interviewed, including 18 in-depth individual interviews and 4 focus groups. Health care providers also were interviewed (n = 24). Data analysis identified four intersecting themes: normalization of social suffering; re-creation of trauma; the challenge of reconciling constrained lives with harm reduction; and mitigating suffering through relational practice. The results highlight the complexities of experiences of accessing systems of care for Indigenous people marginalized by poverty and other forms of social inequity, and the potential harms that arise from inattention to the intersecting social context(s) of peoples' lives. Service delivery that aims to address the mental health concerns of Indigenous people must be designed with awareness of, and responsiveness to, the impact of structural violence and social suffering on peoples' lived realities. A relational policy and policy lens is key to alleviate patterns of social suffering and counter the harms that are unwittingly created when social suffering is normalized.

Is 'another' psychiatry possible?

In this paper, we examine a number of approaches that propose new models for psychiatric theory and practices: in the way that they incorporate 'social' dimensions, in the way they involve 'communities' in treatment, in the ways that they engage mental health service users, and in the ways that they try to shift the power relations within the psychiatric encounter. We examine the extent to which 'alternatives' - including 'Postpsychiatry', 'Open Dialogue', the 'Power, Threat and Meaning Framework' and Service User Involvement in Research - really do depart from mainstream models in terms of theory, practice and empirical research and identify some shortcomings in each. We propose an approach which seeks more firmly to ground mental distress within the lifeworld of those who experience it, with a particular focus on the biopsychosocial niches within which we make our lives, and the impact of systematic disadvantage, structural violence and other toxic exposures within the spaces and places that constitute and constrain many everyday lives. Further, we argue that a truly alternative psychiatry requires psychiatric professionals to go beyond simply listening to the voices of service users: to overcome epistemic injustice requires professionals to recognise that those who have experience of mental health services have their own expertise in accounting for their distress and in evaluating alternative forms of treatment. Finally we suggest that, if 'another psychiatry' is possible, this requires a radical reimagination of the role and responsibilities of the medically trained psychiatrist within and outside the clinical encounter.

Social poetics as processual engagement: Making visible what matters in social suffering.

Social and cultural poetics take us beyond language to an embodied sensibility. To explore the relevance of social poetics in medical training, this article uses as an exemplar an innovative program in geriatrics in a residency program in primary care. The program began with a series of meetings in which medical residents consulted community elders invited for their advice and wisdom on healthcare dilemmas as Senior Faculty, effectively becoming co-teachers and co-learners with one another. Through iterative reflection, residents, faculty and community elders all reported feeling struck by the unexpected responses and were often guided and called to action by them to ask new questions, to shift their stance, or offer greater accompaniment and care. These experiences illuminated what might otherwise have passed by unnoticed, particularly in regards to human suffering. The reflecting process made visible what mattered to each actor, shifting from negative assumptions and attitudes about older adults to a positive engagement with them, co-creating new possibilities for participants to articulate their lived experience of illness and healing. These are creative and moral acts, honoring the voices of those seldom invited to speak, resonating with them, acknowledging what matters to each participant, while taking into account wider issues of disparity and social justice.

Struggling, helping and adapting: Crowdfunding motivations and outcomes during the early US COVID-19 pandemic.

During the early months of COVID-19, many people in the US turned to charitable crowdfunding to seek and provide assistance. Little is known about the needs, hopes or experiences that motivated US pandemic crowdfunding and how these were correlated with campaign success. This study uses a mixed-methods data analysis of a randomised cluster sample of 919 US GoFundMe campaigns during the first 7 months of the pandemic. Overall, most campaigns performed poorly, and 38% got no donations at all. The largest proportion of campaigns aimed to address individual, acute financial struggles, often arising from considerable challenges accessing or qualifying for government assistance. These campaigns, as well as those involving campaigners and beneficiaries of colour, tended to be least successful. Qualitative thematic analysis revealed three key crowdfunding motivations that reflect individualistic, agentive responses to the pandemic: struggling, helping and adapting. These motivations reveal a shift away from social suffering and collective mobilisation and towards largely individualised efforts of survival as digital crowdfunding becomes a key domain of crisis response. Crowdfunding platforms are playing an increasingly important role in mediating and influencing individual and collective responses to crisis, which has important political ramifications for how societies perceive and address health emergencies.

Camadas do sofrimento: impactos psicossociais das medidas de isolamento social em favelas da região metropolitana do Rio de Janeiro / Layers of suffering: psychosocial impacts from social isolation measures in slums of the Rio de Janeiro metropolitan region

Com a pandemia de COVID-19, medidas de isolamento social foram adotadas em escala global. Até 2019, pouco se sabia sobre os impactos desse tipo de estratégia na saúde mental das populações afetadas. Estudos realizados em outras epidemias apontam que indivíduos submetidos a períodos de quarentena tendem a apresentar sintomas de Transtorno de Estresse Pós-traumático (TEPT) e/ou Transtorno Depressivo Maior (TDM). No entanto, para além desta perspectiva psiquiátrica, autores vêm apontando para a necessidade de levar em consideração aspectos socioeconômicos e ambientais na investigação relacionados aos impactos da pandemia, sobretudo em populações que se encontram em situação de vulnerabilidade estrutural. No Brasil, favelas são territórios populacionalmente densos, permeados de pobreza e violência, que possuem muitas vezes habitações precárias, com pouca ventilação, falta de saneamento básico e água potável, fatores que, em si, são dificultantes para o atravessamento do período de isolamento. Nesse sentido, o presente trabalho tem como objetivo investigar os impactos psicossociais advindos de medidas de isolamento social em moradores de favelas da região metropolitana do Rio de Janeiro. Para tal, foram realizadas com 10 participantes moradores de favelas, maiores de 18 anos, entrevistas via Whatsapp de base qualitativa e roteiro semiestruturado. A partir dos resultados encontrados, foi possível inferir que o sofrimento, angústias e aflição dos participantes nesse momento não foram oriunda da pandemia ou de medidas de isolamento per se. Mas sim que a crise de COVID-19 se estabeleceu como um evento crítico que, em concomitância com outros atravessamentos e especificidades, tanto individuais como territoriais, compuseram o quadro de sofrimento dos participantes.

COVID-19 pandemis was responsible for the adpotion of social isolation measures on a global scale. Until 2019, little was known about the impacts of this type of strategy on the mental health of those which were subjected to those measueres. Studies conducted in other epidemics, indicates that individuals that undergone quarantine periods tend to exhibit symptoms of Post Traumatic Stress Disorder (PTSD) and/or Major Depressive Disorder (MDD). However, autores have been poiting to the need of going beyond this psychiatric perspective, and take into account socioeconomic and environmental aspects on investigations related to the impacts of the pandemic, especially of those in situation of structural vulnerability. In Brazil, slums are densely populated territories, permeated by poverty and violence, that often have precarious housing, with little ventilation, lack of basic sanitation and safe drinking-water, factors that are challenges during the period of social distancing. In this sense, this work aims to investigate psychosocial impacts from social isolation measures, on slum dwellers of the metropolitan region of Rio de Janeiro State. For this purpose were conducted via Whatsapp virtual, qualitative interviews with 10 participants who were over 18 years old, and lived on those regions. From the results it was possible to infer that the suffering, anguish and affliction of the participants at this moment did not originate from the pandemic or from isolation measures per se. Rather, the crisis of covid-19 was established as a Critical Event that, together with other smaller events, territorial and invidividual specificities, made up a web of suffering on the subjects of this research.

Social suffering in individuals with chronic obstructive pulmonary disease: a secondary analysis of interpretative phenomenological study.

Individuals with chronic obstructive pulmonary disease experience suffering that affects their families and community relationships. However, no studies provide an explicit account of social suffering among these individuals. This secondary analysis was conducted to understand the lived experiences of social suffering in individuals with chronic obstructive pulmonary disease. The theory of social suffering guided the analysis of an interpretative phenomenological study. Thirteen individuals were recruited using purposive sampling. Data were analyzed using reflexive thematic analysis. Three themes were generated: a) prevailing hopelessness and burden, b) progressing relational adversities, and c) struggling with co-dependency. Social suffering is a complex entity experienced by the patients and the family caregivers. For enhanced caregiving, health professionals could prepare patients to tackle the suffering through collective actions.

Uterine fibroid: a socially malignant illness in Haiti.

This qualitative study documented the effects of uterine fibroids on the suffering of women in Haiti. It makes a unique contribution by re-socializing this disease, by making visible the social inequalities and what is at stake for the women, for their families, and for healthcare delivery. Uterine fibroid is a benign tumor of the uterus, common in gynecology, but profoundly malignant in how it affects women's lives. Little has been reported on their lived experiences. Haiti has historical, social, and economic factors that hinder the search for treatment. The study explores how and why patients seek surgical care for uterine fibroids at Mirebalais University Hospital. Seventeen in-depth interviews with patients and seven accompanying family members were conducted and recorded in Creole and translated into English, along with participant observations in two patients' homes. Content and narrative analysis were done iteratively, and the processual ethnographic method was used to relate our findings to Haitian history, to the context of the study, and to future implications. The women's experience of accompaniment, their suffering in their pèlerinage (care-seeking journey), and the troubling social impact of uterine fibroids make it a socially malignant illness. The study shows that it is critical to address the suffering of women afflicted with uterine fibroids by strengthening the Haitian health system, improving economic advantages, and establishing ways for them to gain access to social goods and participate in community activities.

Stakeholders facilitating hope and empowerment amidst social suffering: A qualitative documentary analysis exploring lives of homeless women with mental illness.

BACKGROUND: Globally homeless mentally ill (HMI) individuals are considered one of the most vulnerable populations. An individual-centric, psychopathology-oriented focus of the existing mental health-care system limits the understanding of the HMI individuals through the disability lens overlooking their strengths and resilience that enable them to survive extremely hostile environments. Contemporary mental health research has embraced a paradigm shift that allows researchers to look beyond the predominant medical model to give precedence to a socio-culturally contexted and experientially firm understanding of human behaviour. AIM: Through the theoretical lens of social suffering, this article attempts to understand the lived experiences of the HMI women, the perspective of their caregivers and the standpoint of service providers in the context of homelessness and mental illness. METHODOLOGY: A documentary analysis as a qualitative research methodology has been used to reflect upon the concerns mentioned above. Following Figueroa's approach to the analysis of audio-visual texts, the documentary Lapata Zindagi, directed by Radhika Lata Murthy, has woven the stories of four HMI women and their caregivers have been analysed. The two-phased analysis involved constructivist grounded theory procedures. RESULTS: The methodological steps, rigour and the resulting categories (experience of social suffering associated with homelessness among HMI women, denial of care and rights within patriarchy, helplessness associated with the burden of caregiving and roles of NGO and community in building hope and empowerment) have been discussed through the lens of social suffering and how stakeholders might facilitate hope and empowerment amidst it. CONCLUSION: The article highlights the dire and urgent need to integrate mental health into primary health care and community-based intervention and move beyond clinical recovery to nurture 'hope' to enable recovery and empowerment for such marginalised populations.

"O ACS é o para-raios": a saúde mental dos agentes comunitários no contexto de reorganização da Atenção Primária à Saúde no Rio de Janeiro / "The HCA is the lightning rod": the mental health of community agents in the context of the reorganization of Primary Health Care in Rio de Janeiro

O município do Rio de Janeiro passou por um processo de reorganização da Atenção Primária à Saúde (APS) entre 2018 e 2020, onde foram suprimidas equipes de Saúde da Família e equipes de Saúde Bucal. As mudanças desconfiguram o modelo da Estratégia Saúde da Família (ESF) e retiram deste modelo de atenção seu protagonismo como estratégia privilegiada para fortalecer a APS. Os Agentes Comunitários de Saúde (ACS) são uma das categorias mais afetadas pela reorganização, uma vez que houve grande redução no número de profissionais e, com a flexibilização dos parâmetros de cobertura populacional, viram seu processo de trabalho extremamente afetado e precarizado. A literatura aponta que existe um componente importante de sofrimento emocional nesses sujeitos, que também demandam cuidados nessa área. A violência estrutural e o sofrimento social aos quais estão submetidos faz destes profissionais um grupo mais vulnerável ao sofrimento emocional. Em virtude do cenário de incertezas que enfrentaram, acredita-se que o processo de reorganização da APS teve impacto sobre a saúde mental dos Agentes Comunitários. Deste modo, o objetivo do presente estudo é investigar como o contexto de reorganização da APS no município do Rio de Janeiro afetou a saúde mental destes profissionais. Para tanto, foram realizadas entrevistas individuais com 9 ACS atuantes em uma clínica da família localizada na zona norte do Rio de Janeiro. De modo geral, os profissionais entrevistados demonstraram sofrimento com as incertezas vivenciadas no período em questão e com as condições precarizadas de trabalho que se seguiram a ele. A situação de precarização que a APS vinha enfrentando foi agravada pela pandemia de COVID-19, com aumento da sobrecarga dos profissionais. A forma como estes profissionais expressaram o sofrimento nas entrevistas pode ser relacionada com o conceito de idiomas de sofrimento. É possível estabelecer relações entre o sofrimento vivenciado pelos agentes comunitários e o processo de reorganização da APS, uma vez que este processo os deixou em uma situação de maior vulnerabilidade. No entanto, não é possível enquadrar este fenômeno em uma categoria diagnóstica, pois o sofrimento destes profissionais aponta para questões sociais e econômicas. Fazer isso seria patologizar a experiência vivida por eles e desconsiderar o sofrimento social e a violência estrutural aos quais estão submetidos.

The city of Rio de Janeiro underwent a process of reorganization of Primary Health Care (PHC) between 2018 and 2020, where Family Health teams and Oral Health teams were suppressed. The changes disfigure the model of the Family Health Strategy (ESF) and remove from this care model its role as a privileged strategy to strengthen PHC. Community Health Agents (CHA) are one of the categories most affected by the reorganization, since there was a large reduction in the number of professionals and, with the flexibility of population coverage parameters, their work process was extremely affected and precarious. The literature points out that there is an important component of emotional distress in these subjects, who also require care in this area. Structural violence and the social suffering to which they are subjected make these professionals a more vulnerable group to emotional suffering. Due to the scenario of uncertainties they faced, it is believed that the PHC reorganization process had an impact on the mental health of Community Agents. Thus, the aim of the present study is to investigate how the context of PHC reorganization in the city of Rio de Janeiro affected the mental health of these professionals. Therefore, individual interviews were carried out with 9 ACS working in a family clinic located in the north of Rio de Janeiro. In general, the professionals interviewed showed suffering with the uncertainties experienced in the period in question and with the precarious working conditions that followed it. The precarious situation that the PHC had been facing was aggravated by the COVID-19 pandemic, with an increase in the overload of professionals. The way these professionals expressed suffering in the interviews can be related to the concept of suffering idioms. It is possible to establish relationships between the suffering experienced by community agents and the PHC reorganization process, since this process left them in a situation of greater vulnerability. However, it is not possible to place this phenomenon in a diagnostic category, as the suffering of these professionals points to social and economic issues. To do so would pathologize their lived experience and disregard the social suffering and structural violence to which they are subjected.

"Na Venezuela eu sou médica. No Brasil, empregada doméstica": des-re-territorialização venezuelana e os impactos psicossociais da reinserção profissional de migrantes com ensino superior / "In Venezuela I am a doctor, in Brazil I am a maid": Venezuelan de-re-territorialization and the psychosocial impacts on professional reintegration of migrants with higher education

A imigração é um fato social completo, presente na história da humanidade e atravessado por diversos saberes e percepções. Assim, busca-se neste trabalho analisar a imigração venezuelana, devido ao seu caráter de questão humanitária e de saúde no Brasil pelo processo migratório fronteiriço. Relatórios dos perfis socioeconômicos de migrantes e, em especial de venezuelanos no Brasil, apontam alto grau de formação superior e de desemprego e ocupações laborais precárias, sobretudo em crises como a instauração da pandemia de Covid-19. Dessa maneira, os efeitos psicossociais da des-re-territorialização e da reinserção profissional de migrantes venezuelanos com ensino superior na cidade do Rio de Janeiro foram investigados. Trata-se de um estudo qualitativo, baseado em entrevistas virtuais com roteiro semiestruturado. A população elegível para o estudo foi estabelecida por indivíduos maiores de 18 anos, de origem venezuelana, com ensino superior completo e residência na cidade do Rio de Janeiro há mais de 2 anos. Para isso, grupos públicos e páginas abertas de redes sociais, como Facebook e Instagram, foram acionados para o convite a participar do estudo, bem como o uso da técnica da bola de neve. As análises do material produzido foram realizadas com base nas teorias do sofrimento social e dos determinantes sociais da saúde. Os testemunhos dos interlocutores venezuelanos possibilitam um outro aporte aos dados identificados nos relatórios, referente às condições precarizadas da vida e do trabalho. Através dos resultados finais, pretende-se auxiliar na construção de políticas públicas e no incentivo da iniciativa privada de gerar renda e oportunidades de trabalho, reconhecendo as formações e as habilidades laborais, além dos impactos do cerceamento de liberdade de transitar e trabalhar em suas áreas profissionais. Para tal, demarca-se como necessário também a diminuição burocrática, o compartilhamento de informações e o alinhamento com os conselhos profissionais. Proporcionando, assim, qualidade de vida, bem-estar e saúde, a partir da autonomia financeira, melhores condições laborais e das circunstâncias da vida, reconhecendo a migração como determinante social da saúde. (AU)

Immigration is a total social fact that has been a part of human history, influenced by various fields of knowledge and perspectives. Thereby, this work seeks to analyze Venezuelan immigration, due to its character of humanitarian and health issues in Brazil through the border migratory process. Reports on the socioeconomic profiles of migrants and, particularly Venezuelans in Brazil, indicate a high degree of higher education, unemployment and precarious work occupations, especially in crises such as the onset of the Covid-19 pandemic. Therefore, the psychosocial effects on de-re-territorialization and professional reintegration of Venezuelan migrants with higher education in the city of Rio de Janeiro which were investigated. This is a qualitative study based on virtual interviews using a semi-structured script. The eligible population for the study was established by individuals over 18 years of age, all from Venezuelan origin, complete higher education and residence in the city of Rio de Janeiro for over 2 years. In consequence, public groups and open pages of social networks, such as Facebook and Instagram, were activated through an invitation to participate in the study, as well as the use of the snowball technique. The analysis of the material produced was based on the theories of social suffering and social determinants of health. The testimonies of the Venezuelan interlocutors offer additional insights into the data identified in the reports, referring to the precarious conditions of life and work. Through the results, it is intended to assist the construction of public policies and in the incentive of the private initiative to generate income and work opportunities, recognizing the training and working skills, as well as the impacts of freedom restriction to transit and work in their professional areas. To this end, bureaucratic reduction, information sharing and alignment with professional councils were also demarcated as necessary. Consequently, providing quality of life, well-being and health, based on financial autonomy, better working conditions and life circumstances, recognizing migration as a social determinant of health. (AU)

"Clara, esta sou eu!" Nome, acesso à saúde e sofrimento social entre pessoas transgênero / "Clara, that's me!" Name, access to health care and social suffering among transgender people / "¡Clara, esta soy yo!" Nombre, acceso a la salud y sufrimiento social entre personas transgénero

Esta pesquisa qualitativa objetivou compreender as relações entre acesso a serviços de saúde e experiências de sofrimento social entre pessoas trans. Foram conduzidas entrevistas semiestruturadas com cinco interlocutores e observações participantes. Os dados foram analisados por meio da codificação temática, originando duas categorias: "A negação do nome" e "Acesso à saúde e transfobia institucionalizada no Sistema Único de Saúde (SUS)". As narrativas das/os interlocutores permitiram localizar tais relações na sociogênese de experiências de sofrimento social. A negação do nome implica negação da humanidade da pessoa trans, bem como patologização de sua identidade e prejuízos no acesso à saúde, colocando a automedicação como uma possibilidade de agência. Concluiu-se que a transfobia institucionalizada no setor de saúde reproduz a precarização da cidadania de pessoas trans, destacando quanto a ação estatal com vistas a mitigar o sofrimento social pode, por vezes, intensificá-lo. (AU)

The aim of this qualitative study was to understand the relationships between access to health services and experiences of social suffering among trans people. We conducted semi-structured interviews with five participants and participant observation. The data were analyzed using thematic coding, giving rise to two categories: "Name denial" and "Access to health care and institutionalized transphobia in Brazilian National Health System". The participants' narratives allowed the researchers to situate these relationships within the sociogenesis of social suffering experiences. Name denial implies the negation of the humanity of trans people and pathologization of their identity, and compromises access to health care, making self-medication a possibility of agency. We conclude that institutionalized transphobia in the public health care system reproduces the precariousness of the citizenship of trans people, highlighting how government actions aimed at mitigating social suffering can sometimes intensify it. (AU)

Esta investigación cualitativa tuvo el objetivo de comprender las relaciones entre acceso a servicios de salud y experiencias de sufrimiento social entre personas trans. Se realizaron entrevistas semiestructuradas con cinco interlocutores y observaciones participantes. Los datos se analizaron por medio de la codificación temática originando dos categorías: "La negación del nombre" y "Acceso a la salud y transfobia institucionalizada en el Sistema Único de Salud". Las narrativas de los interlocutores permitieron localizar tales relaciones en la sociogénesis de experiencias de sufrimiento social. La negación del nombre implica la negación de la humanidad de la persona trans, así como la patologización de su identidad y prejuicios en el acceso a la salud, planteando la automedicación como una posibilidad de agencia. Se concluyó que la transfobia institucionalizada en el sector de la salud reproduce la precarización de la ciudadanía de personas trans, destacando hasta qué punto la acción estatal dirigida a mitigar el sufrimiento social puede, algunas veces, intensificarlo. (AU)

Tramitación del sufrimiento social en Colombia: una mirada a las experiencias comunitarias desde las víctimas del conflicto armado / Processing Social Suffering in Colombia: A Look at Community Experiences from Victims of the Armed Conflict

Resumen La reflexión se plantea desde las formas de tramitación del sufrimiento social producto de la violencia política en Colombia, recogiendo las experiencias locales y comunitarias. Se desprende desde el análisis de contenido realizado a partir de tres tesis de pregrado en el área de la Psicología Social. Se plantean categorias: elaboraciones simbólicas, memoria o liderazgo social, como formas de tramitación y resistencias comunitarias. Las comunidades del dolor se erigen como comunidades de esperanza y apoyo mutuo. Se reafirma el compromiso etico-político de las Ciencias Sociales, frente a la construcción de conocimiento desde las voces y comunidades dolientes, reconociendo saberes otros.

Abstract: The reflection is based on the ways of processing the social suffering resulting from political violence in Colombia, by gathering local and community experiences. It is derived from the content analysis, which is carried out from three undergraduate theses in the area of Social Psychology. The following categories are proposed: symbolic elaborations, memory, or social leadership, as forms of processing and community resistance. The communities of pain are erected as communities of hope and mutual support. The ethical-political commitment of the Social Sciences is reaffirmed, by facing the construction of knowledge from the voices and suffering communities, by recognizing other areas of knowledge.

"Dormindo com a inimiga": imaginário machista em tempos de Covid-19 / "Sleeping with the enemy": male chauvinism's imaginary in COVID-19 / "Durmiendo con la enemiga": imaginario machista en tiempos de Covid-19

Fundamentando-se na Psicologia Psicanalítica Concreta, criada na América Latina a partir da articulação entre a Psicanálise e o pensamento dialético, este estudo objetiva investigar imaginários coletivos machistas sobre mulheres que estão em relacionamentos conjugais heterossexuais, no contexto do isolamento social decorrente da pandemia da covid-19, justificando-se pelo aumento expressivo de ocorrências de violência doméstica nesse período. Organizando-se ao redor da abordagem psicanalítica de memes sobre relações heterossexuais, a investigação permitiu a produção interpretativa de dois campos de sentido afetivo-emocional ou inconscientes intersubjetivos: "Game over" e "Dormindo com a inimiga". Tais campos revelam crenças de que o casamento tira a liberdade do homem casado, privando-o dos prazeres sexuais que mulheres, concebidas como bonecas eróticas, proporcionam aos solteiros, para colocá-lo sob o autoritarismo da esposa, que, fantasiada como figura maléfica, torna-se alvo de uma violência que se apresenta, nesse imaginário, como justificada e legítima.

Substantiated on the concrete psychoanalytic psychology, created in Latin America, based on the articulation between psychoanalysis and dialectical thinking, this study aims to investigate the male chauvinism's collective imaginary about women in a heterosexual conjugal relationships, in the context of the social isolation resulted from the pandemic of the COVID-19, justified by the significant increase in domestic violence occurrences during this period. It is organized around the psychoanalytic approach to heterosexual relationships' memes that enabled the recognition of two affective-emotional meaning fields, or intersubjective unconscious, socially prevailing: "Game over" and "Sleeping with the enemy", which reveal beliefs that marriage takes away men's freedom, depriving them of the sexual pleasures that women, conceived as erotic dolls, provide to singles, to place them under women's authoritarianism. Imaginatively conceived as a maleficent figure, women become targets of an aggressiveness that present, in this imaginary, as justified and legit.

Fundamentándose en la psicología psicoanalítica concreta, creada en América Latina a partir de la articulación entre psicoanálisis y pensamiento dialéctico, este estudio tiene como objetivo investigar imaginarios colectivos machistas sobre mujeres en relaciones conyugales heterosexuales, dentro del contexto del aislamiento social por la pandemia del covid-19, justificado por el aumento expresivo de casos de violencia doméstica en este período. Se organiza alrededor del abordaje psicoanalítico de memes sobre relaciones heterosexuales que permitió la producción interpretativa de dos campos de sentido afectivo-emocional o inconscientes intersubjetivos, socialmente vigentes: "Game over" y "Durmiendo con la enemiga", que revelan creencias de que el casamiento le quita libertad al hombre, privándote de los placeres sexuales que las mujeres, concebidas como muñecas eróticas, brindan a los solteros, para colocarlo bajo el autoritarismo de la mujer. Concebida imaginativamente como figura maléfica, la mujer se vuelve blanco de una agresividad que aparece, en este imaginario, como justificado y legítimo.

"To die is better for me", social suffering among Syrian refugees at a noncommunicable disease clinic in Jordan: a qualitative study.

BACKGROUND: The conflict in Syria has required humanitarian agencies to implement primary-level services for non-communicable diseases (NCDs) in Jordan, given the high NCD burden amongst Syrian refugees; and to integrate mental health and psychosocial support into NCD services given their comorbidity and treatment interactions. However, no studies have explored the mental health needs of Syrian NCD patients. This paper aims to examine the interaction between physical and mental health of patients with NCDs at a Médecins Sans Frontières (MSF) clinic in Irbid, Jordan, in the context of social suffering. METHODS: This qualitative study involved sixteen semi-structured interviews with Syrian refugee and Jordanian patients and two focus groups with Syrian refugees attending MSF's NCD services in Irbid, and eighteen semi-structured interviews with MSF clinical, managerial and administrative staff. These were conducted by research staff in August 2017 in Irbid, Amman and via Skype. Thematic analysis was used. RESULTS: Respondents describe immense suffering and clearly perceived the interconnectedness of their physical wellbeing, mental health and social circumstances, in keeping with Kleinman's theory of social suffering. There was a 'disconnect' between staff and patients' perceptions of the potential role of the NCD and mental health service in alleviating this suffering. Possible explanations identified included respondent's low expectations of the ability of the service to impact on the root causes of their suffering, normalisation of distress, the prevailing biomedical view of mental ill-health among national clinicians and patients, and humanitarian actors' own cultural standpoints. CONCLUSION: Syrian and Jordanian NCD patients recognise the psychological dimensions of their illness but may not utilize clinic-based humanitarian mental health and psychosocial support services. Humanitarian agencies must engage with NCD patients to elicit their needs and design culturally relevant services.

Clever COVID-19, Clever Citizens-98: Critical and Creative Reflections from Tehran, Toronto, and Sydney.

Our world suffers. Some people suffer more than others. Since the first part of 2020, ours is justly described as a time of uncertainty, threat, and upheaval. In this article, we offer reflections threaded narratively, told from the specificity of our societal contexts in Iran, Canada, and Australia. What might we learn in the present and anticipated future from people living chronically within conditions of uncertainty and immobility and also those experiencing uncertainty and immobility for the first time? We argue that reflexive comparative analysis bridging social and visual analysis, anchored in embodied conditions of such people, offers a way to learn from responses to COVID-19 while also being an exercise in ethical research practice. This reflection builds on and extends from our scholarly collaborations that have been ongoing since 2015. Our title recognizes this specific virus as stealthy. Importantly, our choice of words identifies resident Iranians-whose experiences were the original impetuses for this paper, and whose lives provide its empirical basis (98 is Iran's country code)-as equally steely.

Research Trends and Prospects of Medical Anthropology: Concepts and Their Intersection with History of Medicine.

This study explores the history of research in Medical Anthropology by examining key concepts in the field with a focus on their relevance with findings from the field of History of Medicine. The concepts discussed in this paper are Medical Pluralism, Social Suffering, Biopolitics, and Care. Since concepts internalize the ethnographic gaze, what this paper aims is to trace the development of the gaze on a historical axis. Although concepts come from a specific historical period, they are by no means exclusive to it, as they are revisited again and again through various discourses. In other words, the insight that the previous meaning of a concept has grasped is instilled into the revisited concept. In this way, concepts engage in historical communication, create intersections with the interests of History of Medicine. By discussing these intersections with each concept, this paper suggests the complementary roles of the two fields and their approach to historical events and phenomena.