Measuring difference, numbering normal: Setting the standards for disability in the interwar period

Measuring difference, numbering normal provides a detailed study of the technological construction of disability by examining how the audiometer and spirometer were used to create numerical proxies for invisible and inarticulable experiences. Measurements, and their manipulation, have been underestimated as crucial historical forces motivating and guiding the way we think about disability. Using measurement technology as a lens, this book draws together several existing discussions on disability, healthcare, medical practice, embodiment and emerging medical and scientific technologies at the turn of the twentieth century. As such, this work connects several important and usually separate academic subject areas and historical specialisms. The standards embedded in instrumentation created strict but ultimately arbitrary thresholds of normalcy and abnormalcy. Considering these standards from a long historical perspective reveals how these dividing lines shifted when pushed. The central thesis of this book is that health measurements are given artificial authority if they are particularly amenable to calculability and easy measurement. These measurement processes were perpetuated and perfected in the interwar years in Britain as the previously invisible limits of the body were made visible and measurable. Determination to consider body processes as quantifiable was driven by the need to compensate for disability occasioned by warfare or industry. This focus thus draws attention to the biopower associated with systems, which has emerged as a central area of concern for modern healthcare in the second decade of the twenty-first century

Access and utilisation of primary health care services in Riyadh Province, Kingdom of Saudi Arabia

A thesis submitted to the University of Bedfordshire, in fulfillment of the requirements for the degree of Doctor of PhilosophyThe Kingdom of Saudi Arabia (KSA) faces an increasing chronic disease burden. Despite the increase in numbers of primary health care centres (PHCCs) current evidence from the KSA, which is limited overall, suggests that access and utilisation of PHCCs, which are key to providing early intervention services, remain unequal with its rural populations having the poorest access and utilisation of PHCCs and health outcomes. There is a dearth (lack) of information from the KSA on the barriers and facilitators affecting access and utilisation of primary health care services (PHCS) and therefore this study aimed to examine the factors influencing the access and utilisation of primary health care centre (PHCC) in urban and rural areas of Riyadh province of the KSA. The behavioural model of health services use (Andersen’s model) provided the contextual and individual characteristics and predisposing, enabling and need factors which assist with an understanding of the barriers and facilitators to access and utilisation of PHCCs in Riyadh province. A mixed methods approach was used to answer the research questions and meet the objectives of the study. The converged qualitative and quantitative findings show that there are a number of predisposing (socio-demographic characteristics; language and communication and cultural competency) enabling barriers such as; distance from PHCCs to the rural residence, lack of services, new services, staff shortages, lack of training, PHC infrastructure, and poor equipment. Facilitators: service provider behaviour/communication, free PHCS, service provision and improvements, primary health care (PHC) infrastructure, manpower, opening hours, waiting time, and segregated spaces and need (increasing prevalence of chronic diseases, PHC developments in the KSA) factors influencing access and utilisation of PHCS. This study highlights important new knowledge on the barriers and facilitators to access and utilisation of PHCS in Riyadh province in the KSA. The findings have some important policy and planning implications for the MOH in the KSA. Specifically, the findings suggest: the need for clear documentation/guidance on minimum standards against which the PHCS can be measured; an audit of service availability at the PHCCs, regular patient satisfaction evaluations of PHCS, that the MOH take a parallel approach and continue to resource and improve buildings and equipment in existing PHCCs, the recruiting of more GPs, nurses, pharmacists, nutritionists and physiotherapists to meet patient demand and more Saudi health care staff, more targeted health education and interventions for the prevention of chronic diseases in the KSA and the need for an appointment system for attending the PHCCs. There is a need for further research into the barriers and enablers to accessing and utilising health care in Riyadh and the KSA overall. This research would be made easier with a clearer definition of rural and urban in the KSA context which would allow a greater comparability between urban and rural PHCS for future research, audit and evaluation as well as comparison with PHCS in other parts of the world. The Andersen model provided a useful conceptual model to frame this research and provided a structure for contrasting and comparing the findings with other studies that have used the Andersen model to understand the barriers and enablers to accessing and utilising health care services

Measuring difference, numbering normal

Measuring difference, numbering normal provides a detailed study of the technological construction of disability by examining how the audiometer and spirometer were used to create numerical proxies for invisible and inarticulable experiences. Measurements, and their manipulation, have been underestimated as crucial historical forces motivating and guiding the way we think about disability. Using measurement technology as a lens, this book draws together several existing discussions on disability, healthcare, medical practice, embodiment and emerging medical and scientific technologies at the turn of the twentieth century. As such, this work connects several important and usually separate academic subject areas and historical specialisms. The standards embedded in instrumentation created strict but ultimately arbitrary thresholds of normalcy and abnormalcy. Considering these standards from a long historical perspective reveals how these dividing lines shifted when pushed. The central thesis of this book is that health measurements are given artificial authority if they are particularly amenable to calculability and easy measurement. These measurement processes were perpetuated and perfected in the interwar years in Britain as the previously invisible limits of the body were made visible and measurable. Determination to consider body processes as quantifiable was driven by the need to compensate for disability occasioned by warfare or industry. This focus thus draws attention to the biopower associated with systems, which has emerged as a central area of concern for modern healthcare in the second decade of the twenty-first century

The Compatibility of the Access to Essential Generic Medicines with Human Rights: An Analysis of the In-Transit Seizure of Essential Generic Medicines from India by the European Union

The Covid-19 pandemic has sensitised the global community on the importance of the access to essential medicines. The nations of the world have engaged in a fierce battle over the lifesaving Covid-19 vaccines, in which developed nations have come out successfully. The access to essential medicines has long been promoted by the United Nations and other international human rights organisations. This research will also study the case in which a consignment of essential generic medicines from India designated to Brazil was seized, in-transit, by Dutch customs due to a suspected Intellectual Property infringement. Following this incident both India and Brazil filed requests with the World Trade Organization’s Appellate Body to hold consultations with the European Union on the issue of seizure of in transit generic pharmaceuticals by Dutch custom officials. Against this backdrop, this work intends to examine whether the seizure of essential generic medicines from India by the EU is compatible with the standards employed by international human rights law. It will also investigate the impact that European Council Regulation 1383/2003 has on in transit medicine which, by default, was never intended to enter the domestic market of the EU in the first place. In this regard, it is worth noting that both Brussels and New Delhi seems to have much in common, including that they happen to be large democracies with India being the largest in the world. Both adhere to the rule of law, the promotion of human rights and have large economies. New Delhi was also among the first to establish bilateral relations with the European Economic Community in 1963. In recent times, both unions have engaged in negotiations over a bilateral Free Trade Agreement, which has been put on hold. This work endeavours to reflect on the aspect of international trade agreements of the EU. More precisely, it will address the higher IPRs (“TRIPS plus”) standards that seem to be part and parcel of both bilateral and multilateral trade agreements of the EU. It shall also consider both FTA’s and Economic Partnership Agreements of the EU with LDC and developing nations. In addition, it will examine whether the IPRs that are applied by the Brussels could potentially obstruct the full enjoyment of human rights. Finally, the overarching research question of this PhD project is whether the seizure of essential generic medicines from India by the European Union, designated to developing countries, is compatible with the right to health. More precisely, it will further examine whether the access to essential generic medicines could be classified as falling under the category of the right to health (human right) and consequently whether the seizure and subsequent detention of the in-transit cargo of these medicines would qualify as a violation of international human rights law. In this context, it would be relevant to examine whether international human rights law should supersede intellectual property law in cases in which a norm conflict arises. More importantly, this work will assess whether the right to health, in the form of access to medicines, should take precedence over IP law in case of a conflict between both norms. Another issue that will be investigated is whether Brussels’ utilisation of IPRs protection, and the subsequent seizure as well as detention of generic medicines from India, could, potentially, have created a barrier to international trade in the field of generic medicines

Document legalisation (a new approach to the document legalisation process using enterprise network technology)

Documents issued in one country often have to be legalised (authenticated)before they can be used in another country. Different types of documents (legal papers) such as birth, death and marriage records, deeds of assignments, powers of attorney, commercial invoices etc. need to be legalised by the Destination Country before they can be assumed legal. Legalising a document simply means confirming that official documents are sealed and signed either with an Apostille Certificate for countries that are part of the Hague convention 1961, or with a Certificate of Authentication where countries are not party to The Hague Convention. Legalising (authenticating) documents is a process of verification of signatures. The aim of this research is to critically examine the current processes of document legalisation, through analysing and establishing the opportunities that lie before the organisation to implement a new process in document legalisation to replace the prolonged historical process currently used in some countries, specifically the United Arab Emirates (UAE). Using enterprise network technology1, this research will also produce a solution to the risks involved, the implementation and the security, and it will also analyse the impact of such implementation to the organisation. Considering the project, which explores a very sensitive area in the organisation and one of major change to the organisation’s business process, the authenticity of data must be given a high priority. Therefore, an online survey may not always be a legitimate approach. A paper survey may well fit the purpose but, on the other hand, a detailed interview and/ or telephone survey will be even more accurate. Hence I made use of a mixed method (qualitative/ quantitative) approach. The business of document legalisation goes back in history by more than two thousand years and, therefore, needs to be explored historically, establishing how the business of the document legalisation process has evolved alongside the established professions in government today, and defining the areas of concern such as security, availability, traceability and mobility. This will pave the way for an investigation to evaluate a new process that can utilise available technology to solve the areas of concern. The current process of Document Legalisation has been used for many years and a change in this process may take some time. There are many possible pitfalls that the programme may encounter, one of which is the change to a process that has not yet been established in any other area of the world, so there are no other occurrences in this subject for comparison. A clear and informative document explaining the project – a Specific, Measurable, Achievable, Realistic and Time Limit (SMART) description of the project – will solve any conflict. Considering that the research in th is complex topic runs in history for more than two thousand years, a mixed method approach should be used. However, to elaborate the methodology that can explore the underlying philosophical assumption taken by researchers a mixed methodology term should be more accurate, due to the history and composition of knowledge that have been accumulated in this topic. Hence clarification is needed to establish reasons and define a new approach in the document legalisation process. In addition to the historical literature, the main groups taken into consideration to form the data are the decision makers, interviews with senior staff and a survey for employees working in the field of document legalisation. To find reasons for every step in document legalisation, experiments should not be ignored. The reason for this is to clarify the area of data mismatch. The scope of the project will discuss the current risk involved in the current process of legalising documents, identifying its weaknesses, and the needs and requirements of the newly proposed process with recommendations to establish a solution utilising state of the art technology to provide a new secure, mobile and traceable process which is available 24/7

The informal trading of contraceptive pills in Kadoma, Zimbabwe

M.A. (Anthropology)Abstract: The intended purpose of family planning is to allow men and women the right to decide how many children they want to have, when they want to have those children, how to have them and if they want to have them. This paper draws from an ethnographic study that investigates the informal buying and selling of contraceptive pills in Kadoma, Zimbabwe with the main focus of trying to find out why some women would opt for informal means of access. Through the journey of coming to an understanding of this behaviour, a vital theme emerged from the interactions and it is that of autonomy, as some women utilised alternative pathways to access contraceptive pills to ensure they fulfilled their desired outcomes. The investigation of this informal trade was qualitative in nature, with a particular use of participant observation, in-depth semi-structured interviews and field notes. 13 key informants consisting of 12 women who used an array of family planning methods and a population centre ambassador, helped fuel the information that contextualised this dissertation. The experiences the women had with contraceptive devices in relation to their bodies portrayed the individual, social, cultural and political nuances that exist in Kadoma. Also, the existence of pharmaceutical products in the informal space is an indication of the social nature of contraceptive pills in Kadoma

Rethinking Georgian Healthcare: The Patent Medicines Industry in England, 1760-1830

Patent medicines were a major constituent of the healthcare of late Georgian England, but their position in the medical market has escaped the attention of scholars. In this thesis, information from advertisements for medicines in runs of provincial newspapers have been combined with contemporary reports and opinions, surviving printed bills, some preserved financial accounts and official documents to provide a systematic and inclusive account of the industry. My argument is that the production, distribution and sale of patent medicines constituted a stable, substantial and largely respectable industry, with only a minority of its participants being irregular practitioners. The thesis first analyses the status of patent medicines and the imperfect boundary between regular and irregular practice before exploring the functional components of the industry, which include the crucial role of the printed word. The industry employed specific practices from fixed, longstanding, premises, the owners being predominately reputable tradesmen or medical practitioners and the wholesaling being led initially by London booksellers before passing to medicine specialists and chemists. The retail market was national and structured, with the wholesalers organising and paying for much of the publicity. Medicine vending was initially dominated by the newspaper printers and the booksellers, and it was a substantial part of the income of some of them: it was later shared with the druggists. The advertising built up confidence in the medicines by a predominately low-key factual approach and by repetition, and contemporary physicians were aware that this confidence often ensured that the benefits of the medicines were greater than the sum of their pharmaceutical constituents. Thus we can regard the printed word as an essential ingredient of an effective patent medicine. The findings necessitate a reassessment of the late Georgian medical market with the patent medicines industry positioned as a distinct entity, separate from orthodox and irregular medicine, but overlapping both of them

Access to health care for people with disabilities in rural Malawi: what are the barriers?

Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision

Assuring medication safety from board to ward – the role of governance and local cultures

Professional cultures – that is, shared values, attitudes, and behaviours among a professional group – have been identified to play an important role in affecting aspects of patient safety in healthcare. It is argued that these cultures can affirm or contradict an organisation’s safety aims. Despite academic and policy interest, there remains a gap in our understanding of the impact of cultures on the governance and assurance of medication safety. This thesis addresses this gap by conceptualising the role of professional and local ward cultures on the governance and assurance of medication safety across three hospitals within one NHS Foundation Trust. Through an ethnographic lens, this thesis generates detailed insights from structured and unstructured observations (271 hours), interviews (20), and documentary analysis at micro (wards), meso (divisions), and macro (Trust) levels within an organisation to identify the different ‘cultures’ that existed and their relationship with medication safety. The role and influence of cultures, for example professional cultures, was studied at all levels in the organisation. Differing professional ownership existed towards medication safety, giving nurses and pharmacists a more ‘present voice’ than doctors. A focus on inter- and intra-professional working around medication safety identified a fluid conceptualisation of hierarchy across the three study sites. Hierarchical barriers existed but professionals used key tactics to flatten this hierarchy to ensure medication safety. This study also identifies the key role professional cultures play in affecting the implementation of external governance. This role was well acknowledged by senior leaders, yet they identified that they struggled to make changes to medication-specific cultures (e.g. not adhering to a guideline as local norms discouraged it). This study is one of the few to specifically consider the effect of cultures on the governance and assurance of medication safety in an NHS Trust. It also contributes to organisational learning literature by following the operationalisation of two cases of external governance through a complex and multi-layer organisation and identifying the role of cultures at every level of the organisation

To medicate or not to medicate? Exchange, identity and care in everyday household medication practices

In contemporary societies, medications are one of the most commonly used resources for the prevention, treatment, or cure of illness and disease (Shoemaker & de Oliveira, 2008). Despite this, there is a lack of understanding about how medications are used and understood by lay persons in private domestic dwellings. This research explores the medication experiences, understandings, and practices enacted by mothers caring for their chronically ill children. Four households containing children with chronic illness were involved in this qualitative interpretive research. Semi-structured interviews, mapping, diary keeping, and photo-production exercises were utilised to explore the ways in which medications are implicated in caring practices enacted by the mothers. Giddens’ (1984) structuration theory and the concept of ‘gift exchange’ provide the theoretical foundation for this thesis. This research indicates that the medication understandings and beliefs held by the participants are central to the construction of everyday caring medication practices. These beliefs and practices are not fixed or homogeneous, but complex and changeable; reflecting differing contexts, experiences, and forms of knowledge. The agency of parents as they conceptualise ‘care’ and choose to embrace or resist medication use, challenges the notion of ‘passive’ medication consumers. As the use of medication impacts many relationships within and outside of the confines of the household, this thesis highlights the social and symbolic nature of medications. The relationship between a parent and child is central to medication use, but medical decisions made by parents also implicate various other individuals, including health professionals and lay persons. The findings point to the need for health policy which acknowledges and is responsive to, the shifting health needs and understandings of the lay population