Consent to Violence and The Violence of Consent: Martial Arts Training Amongst the Tokyo Police

Martial arts are an integral part of police training in modern Tokyo, a city which enjoys unusually low rates of violent crime considering its size, population density, and economic standing. Having spent 11 months training in Yoshinkan Aikidō together with ten police officers, and then a further 7 months as an instructor, my research focusses on the embodied practices and ritualistic habitus of the specialised training that takes place within the dōjō. From this context I identify key social behaviours of how hierarchy is performed and experienced, and the ways in which care and consent are expressed and demonstrated in various different social situations. Using the dōjō as an example, I then apply these behavioural norms to the wider context of community policing in Tokyo in order to demonstrate how the city is created as a safe space for those who inhabit it. Focusing on embodied forms of communication within strict hierarchies and ritualistic constructions of space, my project looks at how actions of controlled violence are performed, consented to, and balanced with a situation of care in the aikidō dōjō, and what this demonstrates about community policing in Japanese society

Hospital based palliative care in sub-Saharan Africa; a six month review from Malawi

<p>Abstract</p> <p>Background</p> <p>The World Health Organisation recognises the importance of palliative care in an African setting. Despite this services are often patchy and inconsistent, and many operate at health centre and/or community level. Few reports from hospital based palliative care services in sub-Saharan Africa exist in the current literature. As part of its activities Tiyanjane Clinic has been providing hospital based palliative care to patients at Queen Elizabeth Central Hospital, a large government tertiary referral institution, in the Southern region of Malawi since 2003, caring for patients with HIV, cancer and other non-malignant palliative diagnoses.</p> <p>Methods</p> <p>A retrospective review of case notes for all in-patients seen by Tiyanjane Clinic over a six month period (April-Sept 2009) was undertaken.</p> <p>Results</p> <p>A total of 177 patients were seen, for whom 137 case notes were available (77%). 58% of patients were male, 42% female. The average age of patients was 39.1 years (range 15-92 years). 54% of patients were HIV positive, with 34% on ARV drugs at the time of care. 42% of patients had HIV related diagnoses, including AIDS defining malignancies, 48% had (non AIDS related) cancers and 9% had other palliative diagnoses. The mean age of patients with HIV related diagnoses was 34 years, for cancer patients it was 48 years. Pain was the most commonly reported symptom (74%), with 56% of patients requiring oral morphine. The mean daily dose of morphine was 30 mg/day (range 9-100 mg). 65% of patients were discharged home, 26% of patients died during admission.</p> <p>Conclusions</p> <p>The palliative care population in this setting is relatively young, especially among patients with HIV related diagnoses. HIV and cancer are the main diagnostic groups. Pain is the most commonly reported symptom, with oral morphine frequently required. Health workers require access to and knowledge of oral morphine in order to provide appropriate assistance to patients under their care.</p

Underreporting of side effects of standard first-line ART in the routine setting in Blantyre, Malawi

Introduction: In the Malawi ART programme, 92% of 250,000 patients are using the standard first-line regime of stavudine-lamivudine-nevaripine. National ART reports indicate &lt;4% experience ART side effects, much less than expected from literature.Methods: We interviewed adult patients on standard first-line ART for at least one year, after routine visits to an urban clinic in Blantyre, Malawi. We determined the prevalence of symptoms that are common side-effects, described discrepancies between symptoms that patients reported to us and those that had been recorded by attending staff as side-effects in the point-of-care electronic monitoring system, and studied factors associated with such discrepancies.Results: Of 170 participants, 75 (44%) reported at least one symptom, most common were symptoms suggesting peripheral neuropathy (n=57) and lipodystrophy (n=16). Forty-six (66%) symptomatic patients said they reported symptoms to attending ART staff. Side-effects were recorded in the clinic database for just 4 patients. Toxicity recording was too low for meaningful analysis of factors associated with discrepancies between reporting and recording of side-effects. The prevalence of symptoms indicating characteristic side-effects of the standard first-line regimen was 39% based on interviews, and 2% in the electronic monitoring system. Conclusion: There was gross under-recording of side-effects in this setting, mainly due to not recording by ART staff. Pressure of work and insufficient perceived benefit of side-effect recording are suspected causes. Local and national ART reports do not reflect the true toxicity of the standard firstline regimen

Head, heart, hands: social pedagogy in UK foster care

Head, heart, hands: social pedagogy in UK foster car

Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners

Background Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care. Aims We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs\u27 views on using KIS. Methods We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors. Results Overall, 60% of patients were identified for a KIS, a median of 18 weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses. Conclusions GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure

Brexit and the UK-Africa Caribbean and Pacific (ACP) Aid Relationship

Debates about Brexit draw on powerful discursive mechanisms that have important implications for the UK–Africa, Caribbean and Pacific aid relationship. Some of these narratives can be characterized in the following ways: First, that Brexit is an opportunity to recreate a Global Britain after a period of EU membership that saw the UK neglect its former partners, particularly the Commonwealth. Second, the costs of EU membership are profligate and these funds could be better utilized by the national government. Third the Brexit ‘divorce bill’ is a penalty exacted by the EU for the UK’s decision to leave. This article explores these claims via the EU-ACP relationship, and proposes three counter arguments. First, the discourse of ‘neglect’ overlooks the external relationships the UK has maintained through EU membership. Second, these relationships have provided ‘value for money’ for the UK. Third, these contributions represent a significant proportion of the Brexit ‘divorce bill’ and are on-going financial commitments that the UK was central to establishing. The article then reviews the potential impact of Brexit on UK aid, arguing that rather than reinvigorating Global Britain Brexit threatens to undermine the UK’s position in global development, current levels of aid and longstanding commitments to eradicate poverty

An Educational Intervention to Reduce Pain and Improve Pain Management for Malawian People Living With HIV/AIDS and Their Family Carers: A Randomized Controlled Trial

CONTEXT: Advances being made in improving access to HIV drugs in resource-poor countries mean HIV patients are living longer, and, therefore, experiencing pain over a longer period of time. There is a need to provide effective interventions for alleviating and managing pain. OBJECTIVES: To assess whether a pain educational intervention compared with usual care reduces pain severity and improves pain management in patients with HIV/AIDS and their family carers. METHODS: This was a randomized, parallel group, superiority trial conducted at HIV and palliative care clinics of two public hospitals in Malawi. A total of 182 adults with HIV/AIDS (Stage III or IV) and their family carers participated; carer participants were those individuals most involved in the patient's unpaid care. The educational intervention comprised a 30 minute face-to-face meeting, a leaflet, and a follow-up telephone call at two weeks. The content of the educational intervention covered definition, causes, and characteristics of pain in HIV/AIDS; beliefs and myths about pain and pain medication; assessment of pain; and pharmacological and nonpharmacological management. The primary outcome was average pain severity measured by the Brief Pain Inventory-Pain Severity subscale. Assessments were recorded at baseline before randomization and at eight weeks after randomization. RESULTS: Of the 182 patient/carer dyads randomly allocated, 157 patient/carer dyads completed the trial. Patients in the intervention group experienced a greater decrease in pain severity (mean difference = 21.09 points, 95% confidence interval = 16.56-25.63; P < 0.001). CONCLUSION: A short pain education intervention is effective in reducing pain and improving pain management for Malawian people living with HIV/AIDS and their family carers

A palliative care link nurse programme in Mulago Hospital, Uganda: an evaluation using mixed methods

BACKGROUND: Integrating palliative care (PC) and empowering the health care workforce is essential to achieve universal access to PC services. In 2010, 46 % of patients in Mulago Hospital, Uganda had a life limiting illness, of whom 96 % had PC needs. The university/hospital specialist PC unit (Makerere/Mulago Palliative Care Unit –MPCU) implemented a link-nurse model to empower hospital nurses to provide generalist PC. Over two years, 27 link nurses were trained and mentored and 11 clinical protocols developed. The aim of the study was to evaluate the impact of the palliative care link nurse programme at Mulago Hospital METHODS: An evaluation approach utilising mixed methods was used integrating qualitative and quantitative data including: pre and post course assessment confidence ratings; course evaluation forms; audit of clinical guidelines availability; review of link-nurse activity sheets/action plans; review of MPCU patient documentation; Most Significant Change (MSC); individual and focus group interviews. RESULTS: A significant difference was seen in nurses’ confidence after the training (p < 0.001). From July 2012 to December 2013, link nurses identified 2447 patients needing PC, of whom they cared for 2113 (86 %) and referred 334 (14 %) to MPCU. Clinical guidelines/protocols were utilised in 50 % of wards. Main themes identified include: change in attitude; developing new skills and knowledge; change in relationships; improved outcomes of care, along with the challenges that they experienced in integrating PC. Since the start of the programme there has been an increase in PC patients seen at the hospital (611 in 2011 to 1788 in 2013). CONCLUSION: The link-nurse programme is a practical model for integrating PC into generalist services. Recommendations have been made for ongoing development and expansion of the programme as an effective health systems strengthening approach in similar healthcare contexts, as well as the improvement in medical and nursing education

Zagaku: An Auto-ethnographic Account

The majority of this article consists of an unadulterated piece of auto-ethnographic writing depicting a key experience from my anthropological fieldwork. For my PhD research on Japanese policing, I spent two years living in Tokyo and training at the Yoshinkan Aikido Honbu Dojo together with groups of Japanese police officers. This particular dojo has a program called the Senshusei course where Tokyo police officers take part in a nine-month full-time training period that will bring them up to first class black belt instructor level. Alongside the aikido training, the senshusei have other duties such as being responsible for cleaning the entire building, maintaining a training diary, writing weekly essays, and helping at dojo functions. This course removes them from their policing duties for the duration of the training, yet they remain on salary. The Japanese police are encouraged to train in either aikido, judo, or kendo, as well as required firearm practice, as a part of their job. The senshusei course enrols a maximum of ten officers each year, and is just one of many training options available to them for their professional development. From interviews conducted I discovered that, despite being known amongst the Tokyo police for the intensity of the training, completion of senshusei does not necessarily bestow greater importance, respect, or professional status onto those who do it, and most of the officers I trained with signed up simply due to a personal interest in martial arts. A couple of the police told me that judo and kendo have a larger following, so there is apparently less competition if you choose aikido. After completing the course, they are expected to act as instructors to the other officers in their area units (though this is largely dependent on whether anyone is interested). Alongside this, there is a course that civilians can enrol in, of slightly longer duration (eleven months), that trains together with the police and shares all the same duties, usually containing mostly non-Japanese nationals and is therefore known as the International Senshusei or Kokusai Senshusei course. This course has been running since 1990 and was set up due to popular demand from non-Japanese aikido practitioners, many of whom had already been travelling to Japan in order to train for some years. This course is what I undertook and completed in 2017-18. This piece of writing is a first-hand description of one of the aspects of that training, called zagaku: meaning ‘seated learning,’ once a week all senshusei had to spend one full 90-minute training session in seiza, the traditional kneeling position. This practice was derived from the era when Shioda Gozo-sensei (the founder of Yoshinkan Aikido) was still alive and leading the dojo in the late 1990s; it was for all the senseis to attend and reflect on their progress and techniques. This session would usually last around 45mins, during which time everyone had to pay attention to the discussion despite the pain they were in, as Shioda-sensei could call on anyone to contribute at any time. This was a method of training the mind as well as the body, to be able to maintain concentration whilst in significant pain and stress, similar to the meditative practice of zazen performed by Buddhist monks. Ueda-sensei, who had attended these sessions when a young man and was head of the dojo whilst I was there, had been greatly influenced by this practice and decided to implement it for the senshusei course. This decision appeared to be something of a whim, as he had only begun using the practice three years earlier, despite having been in charge of the course for a lot longer (the next year, when a different sensei took over management of the police training, the practice of zagaku was dropped). This experience was incredibly painful and hated by both the police and the international senshusei, yet we all submitted ourselves to its torture at the same time every week. Describing this training to Japanese friends outside of the dojo, they would look at me with horrified disbelief just thinking about how painful it would be, and that was the point; the pain and discomfort were a crucial element of zagaku. Even the senseis felt it despite their decades of practice. This auto-ethnographic piece will form the opening chapter of my PhD thesis, from which starting point I will go on to examine the key themes of pain, discipline, consent, embodied experience, auto-ethnography, methods of learning, behaviours of respect, non-violence, power, and social responsibility within the context of Japan. However, I have made the decision to leave theory out of this article, as the main purpose is for the reader to be given an uninterrupted, embodied taste of the experience as it was lived. There are many academics from various disciplines writing about the theory of pain, but it remains an elusive experience that is rarely described for its own sake. The medical profession still struggles to create methods that patients can use to accurately communicate the intensity and form of their pain, as language is decidedly lacking for such things, so I wanted to use this longer piece as an attempt to communicate what usually remains incommunicable. The anthropology of martial arts is acquiring a strong collection of ethnographies, but descriptions of the embodied experiential elements of training are often cut short to prioritise theoretical analysis. It is an area where the ethnographer often uses their own body as a source of data; training, learning, and getting injured becoming a crucial part of the research methodology. Watching from the side-lines would not have allowed me any insight into the experience of zagaku; the fact that I did experience it, as a researcher, has enabled me to write about it. In order to avoid interrupting my auto-ethnographic description with sections of theory and citations, I have included a further reading list at the end of this piece; a list of books and articles that explore key themes from my research, that readers might find relevant