Weedy Life: Coloniality, Decoloniality, and Tropicality

Respect for any form of life entails nurturing all the potentialities proper to it, including those that might be unproductive from the human point of view. Are there lessons to be learnt about decolonisation of the tropics from a focus on ‘weeds’? The contributors to this photo-essay collectively consider here the lessons that can be learnt about the relationship between colonisation and decolonisation through a visual focus on life forms that have been defined as weeds and, consequently, subject to a contradictory politics of care, removal, and control – of germinating, blooming, and cutting. The essay demonstrates the continuing colonial tensions between aesthetic and practical evaluations of many plants and other lifeforms regarded as ‘invasive’ or ‘out of place’. It suggests a decolonial overcoming of oppositions. By celebrating alliances of endemics and ‘weeds’ regeneratively living together in patterns of complex diversity, we seek to transcend policies of differentiation, exclusion and even eradication rooted in colonial ontology

Dissolving the solid body: an ethnography of birthing in an Australian public hospital

Research Doctorate - Doctor of Philosophy (PhD)Based on ethnographic fieldwork undertaken in the maternity unit of an urban Australian public hospital, this thesis explores metaphors derived from material density as major ordering principles in western understandings of the world, and argues that logics of solidity and fluidity underpin lines of contestation in scientific, academic, and biomedical/health discourses. Through an exploration of social and scientific understandings of the human body, the thesis argues that the body as a fluid, dynamic phenomenon is frequently understood, in biomedical culture, through a logic that is inherently ‘solid’. Solid logic is privileged over fluid logic in hospital environments, which has particular consequences for maternity and birthing care. While medicalised birthing has contributed to improvements in maternal and infant safety and well-being across the western world, inappropriately medicalised birth can be both traumatising and iatrogenic. Feminist contestations to the medicalisation of pregnancy and birth, and obstetric resistance to these contestations, can be seen as contestations between epistemologies centered on (more) fluid or (more) solid understandings of the world. Risk management is shown to be reliant on strategies of material and symbolic solidification, often to the detriment of the inherent fluidity of the maternal body. Constructions of individual autonomy rely on the construction of a bounded body that is often in contradiction with experienced biological corporeality. The thesis argues that fluid logic offers space for maternal corporeality, however the individual autonomy required by the western health consumer is only achievable within a framework of solid logic. Ethnographic engagement with pregnant and birthing women, their partners and families, midwives, obstetricians and other hospital professionals allows for an analysis of embodied and discursive beliefs and practices. The rich complexities of technologised birthing are highlighted in explorations of clinical encounters and key decision making moments in birthing and maternity care

Turning the medical gaze in upon itself: Root cause analysis and the investigation of clinical error

In this paper, we discuss how a technique borrowed from defense and manufacturing is being deployed in hospitals across the industrialized world to investigate clinical errors. We open with a discussion of the levers used by policy makers to mandate that clinicians not just report errors, but also gather to investigate those errors using root cause analysis (RCA). We focus on the tensions created for clinicians as they are expected to formulate 'systems solutions' that go beyond blame. In addressing these matters, we present a discourse analysis of data derived during an evaluation of the NSW Health Safety Improvement Program. Data include transcripts of RCA meetings which were recorded in a local metropolitan teaching hospital. From this analysis we move back to the argument that RCA involves clinicians in 'immaterial labour', or the production of communication and information, and that this new labour realizes two important developments. First, because RCA is anchored in the principle of health care practitioners not just scrutinizing each other, but scrutinizing each others' errors, RCA is a challenging task. Second, thanks to turning the clinical gaze in on the clinical observer, RCA engenders a new level of reflexivity of clinical self and of clinical practice. We conclude with asking whether this reflexivity will lock the clinical gaze into a micro-sociology of error, or whether it will enable this gaze to influence matters superordinate to the specifics of practice and the design of clinical treatments; that is, the over-arching governance and structuring of hospital care.Clinical incidents Root cause analysis Australia Discourse analysis

Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000–14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries

Background: Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0–14 years) and adults (aged 15–99 years) diagnosed with a haematological malignancy during 2000–14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0–24 years). Methods: We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0–14 years), adolescents (15–19 years), and young adults (20–24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. Findings: 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010–14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010–14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000–14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. Interpretation: This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group