To marry or not to marry? : Studying others to know myself

Reflection is integral to ethnographic work; it situates the ethnographer’s insights, beliefs, fears, motivations and confrontations within the larger framework of investigation. But as ethnographers, do we always listen to and act upon our personal reflection? To what extent are we able to go beyond writing reflexively and turn those insights into self-exploration? Using the example of my research on life stories of elderly women in long-term marriages in suburban Mumbai, I explore the relationship between reflexivity and self-exploration. First, I describe my motivation to research this topic. I analyze the contents of reflectional notes from my personal journal and master’s thesis to understand the impact the research had on me. I consider possible explanations for my inability to listen to or accept my own reflections and self-exploration during fieldwork and the consequences on my personal life at the end of the research period

Perceptions of mental illness in a Bangladesh village

In this paper, we discuss the perceptions of people from a Bangladeshi village about what they considered to be 'mental illness'. Observations, informal conversations, interviews, focus group discussions, and illness narratives include the perspectives of both the caregivers and the patients in Kakabo. The villagers provided us with local terms (e.g., paglami), their beliefs about illness causation, treatment, and its effects. Some illnesses were believed to be present from birth and mostly incurable. Supernatural causation and local cure were mentioned for some other categories of illness. There were very few instances when they accessed the existing mental health care in the big city. Widespread abuse of various substances was reported. In general, the participants showed broader acceptance of these conditions, excepting certain forms of substance abuse. We discus these findings in relation to defining their perceptions in terms of explanatory model(s). Our analysis is also concerned with the way people 'embody' their 'illness experience', and how this is made relevant for the process of coping with 'mental illness' in the family. Further investigation, however, is required to clarify some of the questions and ambiguities arising from this small-scale exploratory qualitative study

Perceptions of mental illness in a Bangladesh village

In this paper, we discuss the perceptions of people from a Bangladeshi village about what they considered to be 'mental illness'. Observations, informal conversations, interviews, focus group discussions, and illness narratives include the perspectives of both the caregivers and the patients in Kakabo. The villagers provided us with local terms (e.g., paglami), their beliefs about illness causation, treatment, and its effects. Some illnesses were believed to be present from birth and mostly incurable. Supernatural causation and local cure were mentioned for some other categories of illness. There were very few instances when they accessed the existing mental health care in the big city. Widespread abuse of various substances was reported. In general, the participants showed broader acceptance of these conditions, excepting certain forms of substance abuse. We discus these findings in relation to defining their perceptions in terms of explanatory model(s). Our analysis is also concerned with the way people 'embody' their 'illness experience', and how this is made relevant for the process of coping with 'mental illness' in the family. Further investigation, however, is required to clarify some of the questions and ambiguities arising from this small-scale exploratory qualitative study

Challenges of translational research in cutting edge medical technology : a case of first-in-human (FIH) trials of medical applications of nanotechnology

The translation of discoveries in basic science into safe and effective clinical applications is essential for improving health care. Unfortunately, translational research is a long, arduous and resource intense process filled with high levels of uncertainty and renown for resulting in a series of failures before succeeding in its goal. This is particularly true when cutting-edge medical technologies are translated into improved diagnostic tests or better and safer therapeutic options. The aim of this doctoral research project was to describe the challenges involved in the translational research of medical applications of nanotechnology with a particular focus on first-in-human (FIH) trials. This exploratory research project was situated in a larger study and included in-depth qualitative interviews to gain insight into the perspectives of various stakeholders involved in planning, conducting or evaluating FIH trials in nanomedicine. Translational research is a multi-stakeholder enterprise and often requires the negotiation of various conflicting values and goals. FIH trials mark the moment in translational research when an experimental intervention is tested in human beings first time and poses the highest level of uncertainty with regard to the safety and efficacy. In-depth interviews conducted with expert stakeholders based in Europe and North America led to a greater understanding of the various challenges in translational nanomedicine and potential solutions. The key results of this research project indicate a number of challenges in the current practices of translational research. The results are mainly focused on insights obtained from stakeholder interviews and point to issues such as (1) diverse definitions of nanomedicine and its impact on the translational research, (2) financial, ethical and regulatory challenges in the translational research, (3) inconsistent disclosure practices with regard to the ‘nano’ nature of investigational products in patient information sheets and informed consent forms, (4) implications of the current practices of the researchers of including patients with end-stage cancer and no effective treatment options in FIH trials on the scientific value of the early phases of the translational research and (5) factors such as public health emergencies that can accelerate decision making and mobilize resources to initiate FIH trials with investigational products despite significant uncertainty related to their safety and efficacy. To understand all the complexities of translational research in nanomedicine, there is a need to further investigate the role of various regulatory guidelines and to define ‘meaningful’ public engagement in science and drug development. Both these aspects critically hinge upon scientific integrity and the public’s trust in science and regulatory mechanisms. Although these topics were not investigated in this research project, our results clearly indicate the need to explore them further. We conclude that while discussing the regulation of nanotechnology, careful attention must be paid to each application on a case-by-case basis. We argue for the critical examination of current procedures in regulatory assessments rather than creating new and special regulations for nanomedicine. Finally, we believe that the challenges in translational nanomedicine discussed in this project are also applicable to any cutting-edge medical technology.

Thinking about completed life : euthanasia in the Netherlands from a generativity perspective

In this reflective essay, we explore the concept of generativity and propose it as a more positive interpretation of the experience of ‘completed life’ and its bearing on the wish to die. In 2010, more than 100,000 people in the Netherlands signed a petition requesting an extension of the existing euthanasia legislation. They asked the government to grant euthanasia to older persons who feel tired of life and who regard their lives as complete, in the absence of physical or psychic sickness. Debates about ‘completed life’ euthanasia have continued since then, but the various factions in these debates have been unable to reach consensus or conclusion. In this paper, we analyse the concept of generativity and use this to interpret statements by supporters of ‘completed life’ euthanasia. Next, we disentangle common idioms that people use when they grow older and feel that death is approaching yet still out of reach. The aim of this article is to invite readers to reflect on the wish for ‘completed life’ euthanasia as a meaningful end-of-life reaction

A case study of post traumatic meningitis after a road traffic accident

In road traffic accident cases one of the main reasons for hospitalization is traumatic brain injury (TBI) with subdural hematomas (SDH). The in-hospital course is further complicated by variety of infections including meningitis. A significant concern in the field of bacterial resistance is the multidrug-resistant strain of K. pneumoniae. Due to the dearth of therapeutic options, treating K. pneumoniae infections can be difficult and have an adverse impact on morbidity, mortality, and healthcare-related expenses. Here, we present the case of a 34-year-old polytrauma patient who was in good physical health prior to the road traffic accident. The patient sustained right fronto temporo parietal SDH, frontal contusion, frontal bone fracture, multiple facial bone fracture and CSF rhinorrhoea. He underwent bifrontal craniotomy and ACF repair on the following day. His in-hospital course was complicated by Klebsiella meningitis. He was discharged from the hospital after 25 days of successful treatment of meningitis. In the present study, effective and satisfactory results were achieved through antibiotic therapy which included Colistin IV and intrathecal, Fosfomycin IV, and Tigecycline IV, for a post-operative K. pneumoniae infection. On review day, the CSF analysis had revealed total leucocyte count of 9 and CSF showed no growth

Mixing methods, tasting fingers. Notes on an ethnographic experiment

This article reports on an ethnographic experiment. Four finger eating experts and three novices sat down for a hot meal and ate with their hands. Drawing on the technique of playing with the familiar and the strange, our aim was not to explain our responses, but to articulate them. As we seek words to do so, we are compelled to stretch the verb "to taste." Tasting, or so our ethnographic experiment suggests, need not be understood as an activity confined to the tongue. Instead, if given a chance, it may viscously spread out to the fingers and come to include appreciative reactions otherwise hard to name. Pleasure and embarrassment, food-­like vitality, erotic titillation, the satisfaction or discomfort that follow a meal - we suggest that these may all be included in "tasting." Thus teasing the language alters what speakers and eaters may sense and say. It complements the repertoires available for articulation. But is it okay? Will we be allowed to mess with textbook biology in this way and interfere, not just with anthropological theory, but with the English language itself