Caring for Sexuality and Reproduction: Experiencing community based care and state-run health care in a Ngöbe indigenous community in Costa Rica

The Ngöbe are an indigenous group that resides in the north of Panama and the south Pacific region of Costa Rica. This thesis uses the ethnographic method to examine indigenous Ngöbe women’s practices and experiences of sexual and reproductive health care in a rural community in the southern region of Costa Rica. Indigenous Ngöbe women from El Bajo seek social and medical care practices provided by the community and the state-run health care facility. In their search for well-being, health care seekers consider diverse possibilities within their kin relationships, the community resources, and the state-run health care facility. This thesis also analyses the practices of health care professionals and the subjectivities associated with their work as well as the policies and discourses impacting the state-run sexual and reproductive health care actions, which influences the process of receiving/providing care. This thesis treats care as a practice that is informed by the logics of relationality and individuality. These logics are located in what Bourdieu terms habitus and as such are related to action and not to conscious reasoning. These logics highlight the individual’s relationship to their kin, their community and the environment, as well as the individual’s autonomy in relation to society and nature. These logics inform the practices of both health care professionals and Ngöbe indigenous women and, as a result, the two groups display different combinations of these logics which exist in the form of a spectrum. The actors’ positionalities play a role in shaping the logics within the structure in terms of gender, ethnicity, class, geographic location, and access to biomedical knowledge. Thus, the logics of relationality and individuality are combined in multiple ways; and in the process of exercising their agency people navigate the spectrum according to their possibilities ―social, economic, etc.― based on their positionality within the structure. This thesis follows a comprehensive understanding of women’s exercise of agency through resistance, the inhabiting of norms, and connection and belonging. Consequently, the main focus here is on the Ngöbe women of this community and their experiences and practices of sexual and reproductive health care

eHealth Conversations : using information management, dialogue, and knowledge exchange to move toward universal

The publication of eHealth Conversations, developed with the support of the Spanish Agency for International Development Cooperation (AECID), represents a major step forward for the PAHO/WHO Strategy, since it explores ways of implementing regional mechanisms with free and equitable access to information and knowledge sharing. These initiatives aim to advance the goals of more informed, equitable, competitive, and democratic societies, where access to health information is considered a basic right. This publication is one of the instruments used by PAHO/WHO to develop the initiatives outlined in the Strategy, which coincides with the global eHealth strategy. One of the fundamental needs for the improvement of eHealth is the dissemination of information, and PAHO/WHO is assuming a leading role in this effort. The development of this new electronic publication is a key step in disseminating information that will be useful for decision makers on applying these technologies for the health of the Americas. This electronic book is one of the products of PAHO/WHO’s project: “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health.” Participants in these conversations included experts on electronic health and other specialties. Through virtual dialogues, the experts contributed with knowledge and reflections on the present and the future of eHealth in the Americas, analyzed the situation, and made recommendations for the implementation of electronic health initiatives. These recommendations are not only intended for PAHO/ WHO, but also for governments and the private sector. The aim of the project is to guarantee the convergence of local, national, and regional initiatives regarding the adoption and application of ICTs for public health, with special attention on critical issues in this field. It also intends to strengthen individual and collective capacities of health workers and institutions, connecting them in a network of on-line health networks, as well as to reinforce the PAHO/WHO eHealth program.Acknowledge the Spanish Agency for International Development Cooperation (AECID) for its financial support in preparing this publication and developing the project titled “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health;

Navigating the Tension Between Benevolence and Honesty: Essays on the Consequences of Prosocial Lies

Many of our most common and difficult ethical dilemmas involve balancing honesty and benevolence. For example, when we deliver unpleasant news, such as negative feedback or terminal prognoses, we face an implicit tradeoff between being completely honest and being completely kind. Using a variety of research methods, in both the laboratory and the field, I study how individuals navigate this tension. Each chapter in this dissertation addresses the tension between honesty and benevolence at a different level. In Chapters One and Two, I examine how honesty and benevolence influence moral judgment. In Chapter Three, I explore how honesty and benevolence influence interpersonal trust. In Chapter Four, I explore how honesty and benevolence influence psychological well-being. Finally, in Chapter Five, I examine how different stakeholders view tradeoffs between honesty and benevolence in an important domain: healthcare. Across these chapters, I identify three key themes. First, for moral judgment and interpersonal trust, benevolence is often more important than honesty. As a result, those who prioritize benevolence over honesty by telling prosocial lies, lies that are intended to help others, are deemed to be moral and trustworthy. Second, despite philosophers’ assumption that individuals would rarely consent to deception, I demonstrate that individuals frequently want to be deceived. Individuals want others to deceive them when it protects them from harm. This desire manifests itself in systematic circumstances and during individuals’ most fragile moments. Third, honesty and benevolence are associated with interpersonal and intrapersonal tradeoffs. Although benevolence seems to be more central for interpersonal judgments and relationships, honesty seems to be more central for creating personal meaning. Throughout these chapters, I discuss the implications of these findings for the study of ethics, organizational behavior, and interpersonal communication

Discursive strategies for internal legitimacy:Narrating the alternative organizational form

A significant body of academic work has explored the ways in which hybrid organizations seek to secure external legitimacy. However, there is a more limited understanding of the ways in which organizational units in hybrid organizations seek to acquire internal legitimacy – legitimacy which is conferred by internal stakeholders. This study draws on more than a century of com- munications in a Dutch cooperative bank to uncover how a major organizational unit enacted distinct discursive strategies to seek internal legitimacy. The paper extends prior work by showing how internal legitimacy work – the efforts to shape, reinforce, or suppress internal legitimacy judgments – in a hybrid organization is a dynamic process whereby an internal unit generates multiple complementary narratives to promote a fit between its own attributes and the legitimacy evaluations by internal audiences. In addition, it shows how internal legitimacy work can pro- mote this fit by attempting to manipulate not only the impressions of the internal unit’s attributes, but also its audiences’ understanding of wider cultural norms of the day, on which their legiti- macy judgments are based. In this vein, the paper highlights how discursive internal legitimacy work seeks to generate a taken-for-granted organizational position for the internal units concerned