The role of regulation in influencing income-generating activities among public sector doctors in Peru.

OBJECTIVE: To examine in Peru the nature of dual practice (doctors holding two jobs at once - usually public sector doctors with private practices), the factors that influence individuals' decisions to undertake dual practice, the conditions faced when doing so and the potential role of regulatory intervention in this area. METHODS: The study entailed qualitative interviews with a sample of twenty medical practitioners based in metropolitan Lima, representing a cross-section of those primarily employed in either the private or public sectors and engaged in clinical practice or policy making. The interviews focused on: 1. individuals' experience with dual practice; 2. the general underlying pressures that influence the nature and extent of such activities; and 3. attitudes toward, and the influence of, regulation on such activities. RESULTS: Dual practice is an activity that is widespread and well-accepted, and the prime personal motivation is financial. However, there are also a number of important broad macroeconomic influences on dual practice particularly the oversupply of medical services, the deregulated nature of this market, and the economic crisis throughout the country, which combine to create major hardships for those attempting to make a living through medical practice. There is some support among doctors for tighter regulation. CONCLUSION: Research findings suggest appropriate policy responses to dual practice involve tighter controls on the supply of medical practitioners; alleviation of financial pressures brought by macro-economic conditions; and closer regulation of such activities to ensure some degree of collective action over quality and the maintenance of professional reputations. Further research into this issue in rural areas is needed to ascertain the geographical generalizability of these policy responses

Who Do You Think You\u27re Border Patrolling? : Negotiating Multiracial Identities and Interracial Relationships

Research on racial border patrolling has demonstrated how people police racial borders in order to maintain socially constructed differences and reinforce divisions between racial groups and their members. Existing literature on border patrolling has primarily focused on white/black couples and multiracial families, with discussions contrasting “white border patrolling” and “black border patrolling,” in terms of differential motivations, intentions, and goals (Dalmage 2000). In my dissertation research, I examined a different type of policing racial categories and the spaces in-between these shifting boundaries. I offer up “multiracial interracial border patrolling” as a means of understanding how borderism impacts the lives of “multiracial” individuals in “interracial” relationships. In taking a look at how both identities and relationships involve racial negotiations, I conducted 60 in-depth, face-to-face qualitative interviews with people who indicated having racially mixed parentage or heritage. Respondents shared their experiences of publicly and privately managing their sometimes shifting preferred racial identities; often racially ambiguous appearance; and situationally in/visible “interracial” relationships in an era of colorblind racism. This management included encounters with border patrolling from strangers, significant others, and self. Not only did border patrolling originate from these three sources, but also manifested itself in a variety of forms, including benevolent (positive, supportive); beneficiary (socially and sometimes economically or materially beneficial); protective, and malevolent (negative, malicious, conflictive). Throughout, I discussed the border patrolling variations that “multiracial” individuals in “interracial” relationships face. I also worked to show how people’s participation in border patrolling encouraged their production of colorblind discourses as a strategy for masking their racial attitudes and ideologies about “multiracial” individuals in “interracial” relationships

Shattering Silence and Stereotypes: Rihanna's Lyrical Reaction to Spectacular Violence

In this article, I take up the charge of exploring how the celebrity status of Rihanna allowed audiences to see her humanity, even amidst the dehumanization of her through an objectification supported by media and society.  In the wake of that 2009 incident, Rihanna was denied her privacy specific to these events, largely because of her celebrity status.  In this way, her celebrity proved a double-edged sword, exposing her as a figure provoking the public’s attention and generating cognitive dissonance.  This dissonance stemmed from the illusion that celebrities remain untouched by the harsh realities of everyday life, including intimate partner violence.   That Rihanna became “every woman” even as she remained a superstar held in tension this reality.  This tension speaks to the normalized violence that pervades this society.  Ironically, it is this very celebrity status that helped to shatter the silence of violence

Cooking with Love : Food, Gender, and Power

This work explores the complex relationships between women, food, and power. Engaging the literature of feminist food studies allowed me to record the narratives and examine the experiences of women living in the United States. I take a close look at how women solidify and strengthen their social relationships to family and community through the use of food, or compromise and weaken these relationships through the denial or refusal of food, in the form of cooking or eating. I also consider both local and global contexts for understanding food, in terms of consumption and chores. Finally, I demonstrate how imagery of food allows women to participate in processes of commodification and fetishism

Embodied precarity: the biopolitics of AIDS biomedicine in South Africa

This thesis centres on the lives of women who live in Khayelitsha and who receive AIDS biomedicines through South Africa’s public health system. It is tiered across five ethnographic chapters to elucidate a single overarching argument: biopolitical precarity is networked into the permeable body. This argument is based on ethnographic research and seeks to challenge the discursive construction of distance that divorces women’s lives and bodies from the governance of AIDS biomedicines as life-­giving technologies. The multi-­sited ethnography underpinning this thesis was configured to follow the networked threads that weave women’s embodied precarity into the governance of technologies and the technologies of governance. To this end, fieldwork was conducted in South Africa from October 2010 – July 2011 in order to understand the embodied and political dimensions of access to AIDS biomedicine. Thereafter, fieldwork was conducted in Brazil from August 2011 – September 2011 to explore the networked connections spanning activist organisations, government coalitions and economic blocs to move out from the intimate spaces of women’s lives and bodies to locate them in the regional and global spaces of biomedical developments and health policy dynamics. This thesis argues that although it is crucial to anchor technologies in people’s lives, it is also analytically and politically necessary to link people’s lives - and the technologies that sustain them - back into the global assemblage that is networked around the governance of medicine. Therefore, I locate biomedical technologies in social and political contexts of lives of the people with whom I worked in Khayelitsha, and I argue further that their lives also need to be understood as part of a complex network of actors (spanning international organisations, regional coalitions and national governments) and actants (HIV and ARVs) that assemble in dynamic configurations and that are woven into and through the body

Challenges for gatekeeping: a qualitative systems analysis of a pilot in rural China.

BACKGROUND: Gatekeeping involves a generalist doctor who controls patients' access to specialist care, and has been discussed as an important policy option to rebalance the primary care and hospital sectors in low- and middle-income countries, despite thin evidence. A gatekeeping pilot in a Chinese rural setting launched in 2013 has offered an opportunity to study the functioning of gatekeeping under such conditions. METHODS: In this qualitative study within a mixed-method evaluation of the gatekeeping pilot, we developed an innovative systems analysis method, combining the World Health Organisation categorisation of health system building blocks, the "Framework" approach of policy analysis and causal loop analysis. We conducted in-depth interviews with 20 stakeholders from 4 groups (patients, doctors, health facility managers and government administrators) in the pilot area over two years. Based on information extracted from the interviews, we drew a causal loop diagram which highlighted the feedback loops within the system that had self-reinforcing or self-balancing characteristics, and used the diagram to examine systematically the mechanisms of intended and actual functioning of gatekeeping and analyse the systems level challenges that affected the effectiveness of gatekeeping. RESULTS: Had the gatekeeping pilot programme worked as intended, it would incentivize both providers and patients to increase service utilization at primary care level, as well as establish and enhance two reinforcing feedback loops to shift balance towards primary care. However, a performance-based salary policy undermined the motivation for clinical primary care. Furthermore, the primary care providers suffered from three reinforcing feedback loops (related to primary care capacity, human resource sustainability, patients' faith) that trapped primary care development in vicious cycles. At the interface between hospitals and primary care providers, there were also feedback loops exacerbating the existing hospital dominance. These feedback loops were intensified by the unintended consequences of concurrent policies (restrictions on technologies and medicines) and delayed reform in hospitals. Furthermore, the gatekeeping policy itself faced resistance to further development, due to the prevailing ineffective and ritualistic nature of gatekeeping, which formed a balancing loop. CONCLUSIONS: The study shows that the intended benefits of gatekeeping were illusionary largely due to weak and worsening primary care conditions, and delay, ineffectiveness or unintended consequences of several other ongoing reforms. One particularly dangerous development of the system, which deserves urgent attention, is the harming of the professional prospects of primary care doctors. Our findings highlight the need for coordination and prioritization in designing policies related to primary care and managing changes with multiple on-going reforms. The approach used here facilitates comprehensive study of intended and actual mechanisms, and demonstrates the challenges of a complex health system intervention in a dynamic environment