India: een wereld van verhalen

Als één van de oudste cultuurgebieden op aarde, wordt India sinds de oudheid gekenmerkt door een bijzonder rijke verhalenwereld. Sommige verhalen zijn (deels) gebaseerd op historische gebeurtenissen, andere geheel ontsproten aan de fantasie van getalenteerde vertellers. De regio Zuid-Azië kent een lange en woelige culturele geschiedenis, gekenmerkt door instromen van diverse migrerende en veroverende volkeren, die er allen hun sporen nalieten, uiteraard ook in het verhalencorpus. Bovendien vonden verscheidene wereldreligies, hindoeïsme, boeddhisme, jaïnisme en sikhisme er hun oorsprong, en konden religies als islam er op een heel aparte manier ontwikkelen tot een typisch Zuid-Aziatische vorm. Tegen deze achtergrond geeft dit volume een overzicht van verschillende aspecten van de verhalenliteratuur in India. De omvang van het onderwerp betekent natuurlijk dat er keuzes gemaakt zijn geworden, maar we hebben gepoogd enkele van de meest frappante onderwerpen naar voren te brengen. Dit boek is onderverdeeld in drie grote delen: ten eerste, de klassiekers, ten tweede, verhalen en religie, en ten derde, lokale verhalentradities

Enduring uncertainties. Medical accounts on caring for young people with variations of sex characteristics

Objectives: The diagnosis of intersex or variations of sex characteristics (VSC) often has a big impact on families who fear social stigmatization. Research has shown that intersex populations often experience important health disparities and that poor mental health and daily function are common among youth with VSC. The present study aimed to explore what healthcare professionals of adolescents and young adults (AYA) with VSC find important in terms of care to this group of patients. Methods: Semi-structured interviews were conducted with Swiss healthcare providers involved in the care of youth born with an intersex variation. The qualitative data were analyzed using reflexive thematic analysis. Results: Analysis resulted in six major themes: (1) With regard to patients’ and families lived experiences, interviewees reported that fertility was as a major issue for parents but not for intersex youth as they were said to live in the moment. (2) Respondents considered various forms of psycho-social care (professional support, peer support and informal support from family and friends) to be of fundamental importance for their patients, but many of them seemed critical about support from advocacy groups and activists. All healthcare providers reported significant gaps in (3) the transition process and (4) the establishment of multidisciplinary care teams due to structural, provider- and patient-related barriers. (5) Participants were in favor of a more holistic and patient-centred care approach and (6) were critical about the medicalized use of DSD (disorder of sex development) with patients and families. Conclusion: These findings suggest that although clinicians work hard to implement a holistic approach to care, their intentions are often undercut by a desire to hold a position of medical control. Healthcare professionals need to come to see medical uncertainty not only as a threat but also as an opportunity

Normality in medicine: an empirical elucidation

Background Normality is both a descriptive and a normative concept. Undoubtedly, the normal often operates normatively as an exclusionary tool of cultural authority. While it has prominently found its way into the field of medicine, it remains rather unclear in what sense it is used. Thus, our study sought to elucidate people's understanding of normality in medicine and to identify concepts that are linked to it. Methods Using convenient sampling, we carried out a cross-sectional survey. Since the survey was advertised through social media, we employed an online survey. We performed descriptive and inferential analyses. Predictors were chosen in a theory-driven manner. Results In total, 323 persons from 21 countries completed the survey. Analysis revealed that the overall acceptance of normality in medicine was associated with notions of injustice, authority, discrimination, and with having a medical profession. More precisely, for the field of mental health, injustice insensitivity, genderism and transphobia, and authority were positively associated with a person's acceptance of normality; and, for the field of physical health, injustice insensitivity and having a medical profession were positively associated with a person's acceptance of normality. Finally, participants' acceptance of the use of normality in the area of mental health was lower than in the area of physical health. Conclusions What is considered normal has implications for clinical practice, both at an individual and at a policy-level. Acknowledging its normalistic condition, the discipline of medicine has to confront itself with its own contribution to the augmentation of social inequalities through the excessive reliance on the concept of normality. Research that centers the lived experiences of those who are being systematically marginalized because they are deemed abnormal is needed. By empirically elucidating the conceptual relationships between normality in medicine and other variables, we provide points of leverage to deprive normality of its normative power. For medicine, this is needed to first do no harm

Laryngeal hemiplegia in the horse : an update

Laryngeal hemiplegia is a progressive upper airway dysfunction in the horse. It is not only seen in thoroughbred racehorses but also in warmblood horses, draft horses and in potties. The condition is most frequently seen on the left side. The left laryngeal recurrent nerve gradually loses function and the function of the left cricoarythenoideus dorsalis muscle is compromised. This condition is most often idiopathic. It possibly leads to exercise intolerance but a respiratory noise is often the primary complaint of the owner. Right sided laryngeal hemiplegia is almost always related to other pathologies causing the nerve to malfunction. The diagnosis is not always easy because of the restricted availability of endoscopy in the field. A better understanding of laryngeal ultrasound examination might offer a new possibility in diagnosing laryngeal hemiplegia. If abnormal inspiratory sound is the only problem, laser treatment alone can be satisfactory. If the horse shows clear signs of exercise intolerance, further treatment is needed. If correctly executed, the outcome of laryngoplasty is good. Other techniques, like nerve grafting and pacemakers, are being explored and might even be regarded as better alternative treatments in the future, as these are more physiologic compared to laryngoplasty. In sporthorses presented with idiopathic laryngeal neuropathy without postoperative complications, the prognosis is good

"Waking up" the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature

The aim of the study is to encourage a critical debate on the use of normality in the medical literature on DSD or intersex. For this purpose, a scoping review was conducted to identify and map the various ways in which "normal" is used in the medical literature on DSD between 2016 and 2020. We identified 75 studies, many of which were case studies highlighting rare cases of DSD, others, mainly retrospective observational studies, focused on improving diagnosis or treatment. The most common use of the adjective normal was in association with phenotypic sex. Overall, appearance was the most commonly cited criteria to evaluate the normality of sex organs. More than 1/3 of the studies included also medical photographs of sex organs. This persistent use of normality in reference to phenotypic sex is worrisome given the long-term medicalization of intersex bodies in the name of a "normal" appearance or leading a "normal" life. Healthcare professionals should be more careful about the ethical implications of using photographs in publications given that many intersex persons describe their experience with medical photography as dehumanizing. Keywords: DSD; Ethics; Intersex; Normality; Phenotyp

De Indische epen en de Jains

The Indian Epics and the Jains. — Traditional stories, and the values they represent in the actions of their protagonists, continue to play an important role in the daily life in South Asia. Rāma, the hero of the Sanskrit epic Rāmāyaṇa, became the ideal political leader. Similarly, the heroics described in the other Indian epic, Mahābhārata, have become an inspiration for many. Characteristic of these epics is the fact that throughout history authors from different backgrounds created their own version of these stories, adapted to their specific audiences. This is also the case for authors who follow jainism, a religious tradition focussing on the ideal of the non-violent, wandering ascetic. This paper explains how the Jains approached these epics.Traditionele verhalen, de normen en waarden die zij vertegenwoordigen in de daden van hun protagonisten, spelen tot op de dag van vandaag een belangrijke rol in het maatschappelijke leven van Zuid-Azië. Zo stond Rāma, de held uit het Sanskrit epos Rāmāyaṇa, model voor de ideale politieke leider. Ook de wapenfeiten uit het andere epos, Mahābhārata, vormen een bron van inspiratie voor velen. Kenmerkend aan deze epen is dat doorheen de geschiedenis auteurs van diverse achtergronden er eigen versies van zijn gaan scheppen, aangepast aan hun eigen publiek. Zo ook dichters die het jainisme aanhangen, een religieuze traditie waarin het ideaal van de geweldloze, rondzwervende asceet centraal staat. Dit artikel bespreekt hoe de Jains deze epen benaderden