The Indigenous Healing Tradition in Calabria, Italy

In 2003, the four of us spent several weeks in Calabria, Italy. We interviewed local people about folk healing remedies, attended a Feast Day honoring St. Cosma and St. Damian, and paid two visits to the Shrine of Madonna dello Scoglio, where we interviewed its founder, Fratel Cosimo. In this essay, we have provided our impressions of Calabria and the ways in which its native people have developed indigenous practices and beliefs around medicine and healing. Although it is one of the poorest areas in Italy, Calabria is one of the richest in its folk traditions and alternative modes of healing. Combining personal experiences and theoretical knowledge, this paper aims at illuminating how these practices, though indigenous and primal, still continue to serve a meaningful and powerful purpose for the inhabitants of Calabria

Implementation of the World's largest measles-rubella mass vaccination campaign in Bangladesh: a process evaluation

Background: Gavi, the Vaccine Alliance, supported a mass vaccination Measles-Rubella Campaign (MRC) in Bangladesh during January–February 2014

Moral worlds and therapeutic quests : a study of medical pluralism and treatment-seeking in the lower Amazon

This dissertation is about the social and psychocultural dimensions of medical pluralism and treatment seeking in Santarém, a rapidly growing municipality in the Brazilian Amazon. Based on a year-and-a-half of ethnographic fieldwork in urban and rural settings, it comparatively examines how popular religions and cosmopolitan health institutions define and manage (or fail to manage) sickness, psychosocial impairment, and emotional distress. It also reveals lived experiences of informants who seek out these therapeutic options and the processes through which quests for healing shape personal understandings of affliction and selfhood. This study contributes to emerging scholarship in anthropology that theorizes medical pluralism, not in terms of discrete cultural systems set in opposition to one another (e.g., traditional versus cosmopolitan medicine), but rather as an open system of dynamic relations between institutions and between institutions and care-seekers. This dissertation situates these processes within broader historical trends in the Amazon that have lead to significant patterns of urbanization, migration, and sociocultural complexity, contrary to popular stereotypes of the region. In this context, religious institutions such as Pentecostalism, Spiritism, Candomblé, and Umbanda have flourished and, along with secular health institutions, provide diverse social and symbolic resources for the needs of care-seekers. However, an examination of the ways that santarenos in these communities cognize illness and distress and seek care reveals how blurred the boundaries are between institutional ideologies and therapeutic practices. These domains are characterized as much by complementarity as by contradiction. In similar light, individual treatment seeking efforts do not unfold in any clear-cut fashion. Rather, informants find themselves caught up within epistemic entanglements, as they navigate moral worlds oriented to medicalized care, ritual forms of healing, and spirit mediumship. Case studies convey personal dilemmas that emerge from these entanglements, in which individuals strive to regain control of symptoms, of self- and social efficacy, and moral development. Psychocultural theories, including the work of culture and embodiment, provide a framework for understanding how differing cultural idioms articulate with these life-course themes, emotions, and sensory experiences, which together underpin expressions of flexibility in selfhood in response to social conditions of pluralis

Moral worlds and therapeutic quests : a study of medical pluralism and treatment-seeking in the lower Amazon

This dissertation is about the social and psychocultural dimensions of medical pluralism and treatment seeking in Santarém, a rapidly growing municipality in the Brazilian Amazon. Based on a year-and-a-half of ethnographic fieldwork in urban and rural settings, it comparatively examines how popular religions and cosmopolitan health institutions define and manage (or fail to manage) sickness, psychosocial impairment, and emotional distress. It also reveals lived experiences of informants who seek out these therapeutic options and the processes through which quests for healing shape personal understandings of affliction and selfhood. This study contributes to emerging scholarship in anthropology that theorizes medical pluralism, not in terms of discrete cultural systems set in opposition to one another (e.g., traditional versus cosmopolitan medicine), but rather as an open system of dynamic relations between institutions and between institutions and care-seekers. This dissertation situates these processes within broader historical trends in the Amazon that have lead to significant patterns of urbanization, migration, and sociocultural complexity, contrary to popular stereotypes of the region. In this context, religious institutions such as Pentecostalism, Spiritism, Candomblé, and Umbanda have flourished and, along with secular health institutions, provide diverse social and symbolic resources for the needs of care-seekers. However, an examination of the ways that santarenos in these communities cognize illness and distress and seek care reveals how blurred the boundaries are between institutional ideologies and therapeutic practices. These domains are characterized as much by complementarity as by contradiction. In similar light, individual treatment seeking efforts do not unfold in any clear-cut fashion. Rather, informants find themselves caught up within epistemic entanglements, as they navigate moral worlds oriented to medicalized care, ritual forms of healing, and spirit mediumship. Case studies convey personal dilemmas that emerge from these entanglements, in which individuals strive to regain control of symptoms, of self- and social efficacy, and moral development. Psychocultural theories, including the work of culture and embodiment, provide a framework for understanding how differing cultural idioms articulate with these life-course themes, emotions, and sensory experiences, which together underpin expressions of flexibility in selfhood in response to social conditions of pluralis

The role of shame in posttraumatic stress disorder: A proposal for a socio-emotional model for DSM-V

Posttraumatic stress disorder (PTSD) is one of the emblematic psychiatric conditions in contemporary public consciousness, indexing not only disordered minds, but also disordered human relations. With efforts currently mounting to refine criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), an important task is to re-examine the emotional foundations of trauma and their elaboration in social context. A body of clinical research on psychological trauma indicates that the emotion shame is central to the development and course of PTSD. However, current diagnostic criteria and bio-behavioral research do not account for these findings. In light of an emerging understanding of PTSD as a disturbance of affect systems (Stone, 1992), this paper proposes a novel theoretical model that describes how shame underlies peri-traumatic and posttraumatic experiences of threats to the social self. It first presents a rationale for investigating traumatic shame that draws on affect theory and current findings in PTSD research. Next, it discusses the foundations of shame in perceptions of status inferiority and failure to conform to normative expectations and their elaboration in PTSD. Then it describes psychological, social, and cultural domains that are critical for contextualizing shame meanings and expressions. Finally, it recommends revisions to the diagnostic criteria for PTSD in DSM-V.Shame Trauma Social self Posttraumatic stress disorder Emotion Culture DSM-V

Frontline health workers as brokers : provider perceptions, experiences and mitigating strategies to improve access to essential medicines in South Africa

BackgroundFront-line health providers have a unique role as brokers (patient advocates) between the health system and patients in ensuring access to medicines (ATM). ATM is a fundamental component of health systems. This paper examines in a South African context supply- and demand- ATM barriers from the provider perspective using a five dimensional framework: availability (fit between existing resources and clients¿ needs); accessibility (fit between physical location of healthcare and location of clients); accommodation (fit between the organisation of services and clients¿ practical circumstances); acceptability (fit between clients¿ and providers¿ mutual expectations and appropriateness of care) and affordability (fit between cost of care and ability to pay).MethodsThis cross-sectional, qualitative study uses semi-structured interviews with nurses, pharmacy personnel and doctors. Thirty-six providers were purposively recruited from six public sector Community Health Centres in two districts in the Eastern Cape Province representing both rural and urban settings. Content analysis combined structured coding and grounded theory approaches. Finally, the five dimensional framework was applied to illustrate the interconnected facets of the issue.ResultsFactors perceived to affect ATM were identified. Availability of medicines was hampered by logistical bottlenecks in the medicines supply chain; poor public transport networks affected accessibility. Organization of disease programmes meshed poorly with the needs of patients with comorbidities and circular migrants who move between provinces searching for economic opportunities, proximity to services such as social grants and shopping centres influenced where patients obtain medicines. Acceptability was affected by, for example, HIV related stigma leading patients to seek distant services. Travel costs exacerbated by the interplay of several ATM barriers influenced affordability. Providers play a brokerage role by adopting flexible prescribing and dispensing for `stable¿ patients and aligning clinic and social grant appointments to minimise clients¿ routine costs. Occasionally they reported assisting patients with transport money.ConclusionAll five ATM barriers are important and they interact in complex ways. Context-sensitive responses which minimise treatment interruption are needed. While broad-based changes encompassing all disease programmes to improve ATM are needed, a beginning could be to assess the appropriateness, feasibility and sustainability of existing brokerage mechanisms