Situating Latin American Critical Epidemiology in the Anthropocene: The Case of COVID-19 Vaccines and Indigenous Collectives in Brazil and Mexico

Diverse histories and traditions of critical epidemiology in Latin America provide an important, although underutilised, alternative framework for engaging with the embodied health inequalities of the Anthropocene. Taking COVID-19 as ‘a paradigmatic example of an Anthropocene disease’ (O’Callaghan-Gordo and Antó 2020) and drawing on ethnographic research in Brazil and Mexico on vaccination campaigns among Indigenous Peoples, we review and analyse the scope and limits of Latin American critical epidemiology in addressing Anthropocene health. While there are intersecting and parallel dynamics between diverse national and regional histories of epidemiology, we argue that the relatively differential focus on political economy, political ecology, and colonialism/coloniality in Latin American critical epidemiology, alongside the attention to non-western disease experiences and understandings, constitute a counterpoint to biomedical and specific ‘Euro-American’ epidemiological approaches. At the same time, Indigenous understandings of health/disease processes are intimately connected with territory protection, diplomacy with non-human entities, and embodied memories of violence. We examine how this presents new and challenging questions for critical epidemiology, particularly in how the ‘social’ is defined and how to address both social justice and social difference whilst also navigating the biopolitical challenges of state intervention in the era of Anthropocene health

The Stories We Tell or Omit​: How Ethnographic (In)Attention can Obscure Structural Racism in the Anthropology of Mental Healthcare

Anthropologists studying mental healthcare tend to do so through observational and analytic attention to how individuals experience specific clinical and cultural contexts. While narrating lived experience may serve to humanise conditions like mental illness, those of us observing from a White, colonist-descended position can overlook the structural and racialised forces that determine entrance into particular treatment spaces. In doing so, we inadvertently obscure structural racism. This Position Piece critiques my approach as a student-in-training in anthropology, who conducted an ethnography of outpatient, government-funded clozapine clinics in the United Kingdom and Australia. In documenting how these clinics unexpectedly became a central source of moral agency for its clients, I stopped short of examining the demographic dynamics that helped to cultivate moral agency. Focused on other questions of health disparity, I missed the role of race and racism in treatment access pathways, trustworthiness, and experiences of moral agency. Engaging now with disciplinary legacies that shaped my inattention, I reflect on my silencing of racism at an interpersonal, institutional and structural level in my early analysis. I encourage similarly positioned anthropologists studying psychiatric treatment spaces and moral experience to confront how racism can be filtered through the stories we tell.&nbsp

Turning Cancer into Medicine: Storying Healing through Imagery

This Photo Essay explores my experience with cancer and healing using Indigenous traditional medicines. I use Photo First Voice, a form of auto-ethnography, to story my ‘living’ experience with cancer, which includes getting in touch with and honouring my Indigenous roots (Algonquin/French) attending healing ceremonies, and becoming an Oshkaabewis (a healer’s helper) myself. I integrate photographic images into this essay to illustrate my experiences and to enhance the meaning of the words I have committed to these pages. Each image represents a different aspect or level of knowledge and healing. These images and text are followed by a discussion in which I weave fragments of experience together to narrate a living (inter)relationship with the earth, towards a more balanced whole. Indigenous medicines set in motion major changes in my life, which are fundamental to my ongoing healing. In this context, the term ‘medicine’ refers to Indigenous knowledges that contribute to healing, healing ceremonies, teachings, and plant medicines (mainly Ojibwe)

'We Still Living': The Digital Media and Fake-talk around COVID-19 in Tanzania

In Tanzania, as COVID-19 emerged and became a pandemic, many claims about the fakeness of virus-related news began to appear in the digital media. These claims, or what I refer to as ‘fake-talk’, served to expose and discredit ostensibly false information and distinguish it from real news. However, I suggest that these instances of ‘fake-talk’ have a deeper sociopolitical meaning. Analysing posts collected between August 2020 and May 2022, I argue that such instances are performative acts of citizenship, whereby Tanzanians enacted and embodied ‘good’ citizenship when ‘fake news’ appeared to criticise their country and its leaders. This fake-talk, the paper shows, follows a pattern in Africa of criticising Western science and medicine, and can therefore be understood as an example of a specific form of postcolonial citizenship. Additionally, the paper reveals that claims about fakeness do not necessarily discredit the entities referred to as ‘fake’. Instead, in the very process of decrying something as ‘fake’, fake-talk can create a spectacle. Further attention still may be directed to it when fake-talk gives rise to moral and legal concerns that require intervention

Screening Charity Recipients: Health Philanthropy, Medical Diagnosis, and Kidney Disease Prevention in Sri Lanka

Over the last several decades, epidemics of chronic kidney disease of unknown aetiology (CKDu) have appeared in Mesoamerica, North Africa, and South Asia. Drawing on 14 months of ethnographic fieldwork in a CKDu-affected village in Sri Lanka, I explore how one CKDu ‘hotspot’ came into being following population screening interventions by a community development organisation, a philanthropic foundation, and a university research group. While the production of test results proved vital to the mobilisation of further research and public health resources for the community, this ethnography reveals philanthropy could be seen to have shaped by screening as much as screening was seen to have influenced by philanthropy. The example of medical screening and philanthropic interventions in Ginnoruwa illustrates how bioindicators of failing kidney function became a key metric for demarcating the community into populations of the deserving (or not so deserving) poorly, which in turn helped to create the pattern of disease prevalence and concentration that led to the community being designated a ‘hotspot’. In Ginnoruwa, philanthropy and screening did not operate independently but constituted a novel hybrid, which I refer to as ‘philanthropic science’

Giving Birth in Silence

Jacinta, deaf from birth, chose to give birth to her own baby at home without her hearing aids. Fu-Yu assisted and took photos of the process. This is a Photo Essay about alternative possibilities to biomedical childbirth. We share our experience through this medium, as the ‘visual’ was our shared sensory perception at the time. Besides acknowledging the intersubjectivities that surfaced, we see the importance of recognising that ‘images are representations of the world filtered by the positionalities of the makers themselves, influenced by unique experiences that brought them to that point in time … Images become an extension of a way of thinking, visually connecting maker with participant along lines of thought’ (Cartwright and Crowder 2017, 515). Although Fu-Yu is the one operating the camera, Jacinta, her partner, her mother, her cat and her home ‘make the image’. Whilst Jacinta was in labour, Fu-Yu was assisting Carmen Susana (the midwife) and recording the event at the same time with a camera hanging around her neck. We want to offer the audience this shared ‘visual’ experience as an invitation to think and ‘visualise’ care and childbirth from a disability-studies perspective

Thinking the Self through Hooks, Needles, and Scalpels: Body Suspensions, Tattoos, and other Body Modifications

Body modifications such as tattoo, scarification and body suspension represent not only aesthetic interventions, they can also be social practices with which to challenge and transcend the body’s limits, operating on the perception of wellbeing and moulding specific forms of self. In this Research Article, based on research on body suspension in Europe, I aim to analyse body modifications as a means to voluntarily intervene in human perceptive abilities, shaping individual lives through unconventional sensory experiences. In these practices, pain is signified as a threshold for sensory turmoil, capable of shaping the protagonists into a ‘sensory poiesis’. Through such sensory experiences the individual embarks on a process of ‘self-design’ to achieve a better state of being, combining suspensions with other body modification techniques. Suspension practitioners act on the flesh and skin with hooks, scalpel, and ink in order to process events, to trigger new versions of the self, and to enhance how they feel. In doing so, they produce unique and original ‘projects of humanity’, that is, new forms of humanity created by the individuals themselves

Fake-talk, Side Effects and the Trouble with Hormonal Contraceptives among Women in Dar es Salaam

This article analyses women’s accounts about hormonal contraceptives in Tanzania, and the social, cultural, political, and economic contexts that cause them to use such contraceptives, even as they called them ‘feki’ (Swahili for fake). Drawing on four months of ethnographic fieldwork and interviews with four working-class women from various districts in Dar es Salaam, my research explores their anxieties about using these medications, the side effects of which they believe pose a threat to their health. The possible biomedical side effects the women spoke of include prolonged menstrual cycles, stomach cramps, fibroids, cancer, and infertility. They reasoned that medicine should not bring suffering to the body, and that therefore, if a woman experiences side effects it is a matter of concern. Given that all medications have side effects, I was interested in what exactly these women meant when they identified hormonal contraceptives as ‘feki’. Furthermore, if they believed that these contraceptives were fake, why did they continue to use them? Over time, I came to understand that calling hormonal contraceptives ‘feki’ did not mean the women thought the pharmaceuticals were inauthentic or ineffective in preventing pregnancy. Rather, it reflected their view of such drugs as being morally problematic, but sometimes necessary

"Swallow Them All, and It's Just Like Smack": Comorbidity, Polypharmacy, and Imagining Moral Agency alongside Methadone and Antipsychotics

This research article investigates moral agency in the spaces between the methadone clinic and the inpatient psychiatric ward by exploring the ways dually-diagnosed service users move though ever-more labyrinthine networks of care. I ask: how are patients’ own engagements with the ethical stakes of such care both made possible and delimited by virtue of their proximity to substances that are understood to affect their subjectivities, wills, and capacities for self-governance? Drawing on fieldwork in the community mental health network of Dublin, Ireland, and following my interlocutors’ own reflections, I analyse the moral dimensions of polypharmaceutical treatment for substance use disorder in the context of psychiatric dual diagnosis. I illustrate how various apparatuses of coercion and care apprehend and govern patients who are thought to be both addicted and mad, simultaneously enthralled by one form of the pharmakon and dangerously unreasonable when other medications are absent or neglected. In the space of such medicated subjectivities, a curious but ultimately revelatory claim to authority about the intended and unintended effects of polypharmaceutical treatment takes shape.&nbsp

The Anthropologist as Audience: Engaged Listening among Khmer Rouge Survivors and Ukrainian War Refugees

Although the Khmer Rouge regime was responsible for the deaths of roughly 2.2 million Cambodians—and the persecution and abuse of millions more—only a handful of survivors have been able to testify at the tribunal established to prosecute former leaders of the regime. Partly to address this gap, an NGO affiliated with the tribunal has been offering ‘Testimonial Therapy’ for the past decade as a form of reparation for survivors with symptoms of psychological distress. For 16 months, I followed survivors undergoing this therapy, during which they developed a testimonial narrative of their life story in collaboration with a local mental health worker. In this Position Piece, I consider Myers’ conception of ‘moral agency’ (2015) in relation to this process of personal narrative creation, and the critical importance of audience engagement. I then reflect on my own positionality as both ethnographer and active listener, tracing how this affective posture has been formed not only through fieldwork, but also through engagement with family narratives of loss in the context of war-torn Ukraine