Circles of care: healing practices in a Bahian Candomblé community

This thesis explores the dynamics of healing and care in a terreiro (house of worship) of the Afro-Brazilian religion Candomblé. My research is based on one year of ethnographic fieldwork with a Candomblé community in South Bahia, Brazil, during which I took part in the rituals, ceremonies, and everyday activities of the terreiro, and eventually became a ‘daughter of the house’. While the terreiro is at the heart of this study, I also draw upon observations and experience from the local neighbourhood, the nearest city Ilhéus, the state capital Salvador, and the city of Rio de Janeiro, where I started my journey, to complement and contextualize what I encountered inside the terreiro. I argue that cuidado, or care, is key to the cultivation of Candomblé’s vital force axé, and hence to achieving well-being and power in a socially exclusive society that is often perceived as profoundly uncaring. My thesis demonstrates that the circulation of axé and cuidado between humans and gods (orixás) is an essential part of Candomblé healing, understood as a process of reflexive self-transformation. Far from being altruistic or self-denying, then, cuidado effectively becomes a form of self-care. Subverting dichotomous logic, Candomblé cuidado is used to create and negotiate (healing) power through its capacity to simultaneously connect and divide. This thesis explores how boundaries are both transgressed and reinforced by way of cuidado in terms of transformative healing; kinship relations with the orixás; the exchange of human faith (fé) for divine axé; and performances on ‘divine stages’ and ‘profane stages’. Finally, cuidado is also used as a moral-political argument for the recognition of Candomblé in public health campaigns, in the context of an often-dysfunctional public health system. The analysis of dynamics of cuidado and boundary work in a terreiro, under consideration of the broader national context, makes this thesis an original contribution to the literature on Afro-Brazilian religion and healing. My ethnography also adds to the growing literature on the anthropology of care, especially in medical anthropology, and it pushes forward the discussion by explicitly reflecting on the circulation and negotiation of power through care

A forum on the Zika virus

Luciana Brondi – ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository.http://somatosphere.net/2016/a-forum-on-the-zika-virus.html

Life Quality Impairment Caused by Hookworm-Related Cutaneous Larva Migrans in Resource-Poor Communities in Manaus, Brazil

Hookworm-related cutaneous larva migrans (CLM) is a parasitic skin disease common in developing countries with hot climates. In resource-poor settings, CLM is associated with considerable morbidity. The disease is caused by animal hookworm larvae that penetrate the skin and migrate aimlessly in the epidermis as they cannot penetrate the basal membrane. Particularly in the rainy season, the intensity of infection is high with up to 40 larval tracks in an affected individual. Tracks are very itchy and are surrounded by a significant inflammation of the skin. Bacterial superinfection is common and intensifies the inflammation. The psychosocial consequences caused by CLM have never been investigated. We showed that CLM causes skin disease-associated life quality impairment in 91 patients with CLM. Skin disease-associated life quality was significantly impaired. The degree of impairment correlated to the intensity of infection and the number of body areas affected. After treatment with ivermectin, life quality was rapidly restored

stigma and everyday-life in a former leprosy colony in Northeast Brazil

Viele Krankheiten führen zu sozialer Isolation. Eine jedoch ist geradezu der Inbegriff von Ausgrenzung: die Lepra. Die durch M. leprae hervorgerufene Infektionskrankheit kann – wenn nicht rechtzeitig antibiotisch behandelt – zu stark stigmatisierenden Veränderungen des Gesichtes und der Extremitäten führen. Den sozialen Folgen der Lepra ist somit eine ebenso hohe Bedeutung einzuräumen, wie dem körperlichen Leiden. Die räumliche Isolation Leprakranker wurde schon im Alten Testament vorgeschrieben – in Brasilien war sie noch bis 1962 gesetzlich verordnet. Einige ehemalige Leprakolonien werden noch immer bewohnt – so auch das 1928 eingerichtete, staatlich verwaltete „Zentrum des Zusammenlebens Antônio Diogo“ (CCAD) im brasilianischen Bundesstaat Ceará, obwohl es den Bewohnern seit 1981 erlaubt ist, die Einrichtung zu verlassen. Eine strukturierte Erfassung der Lebensumstände und der sozialen Exklusion in den ehemaligen Leprakolonien Brasiliens liegt bisher nicht vor. Die vorliegende Studie mit interdisziplinärem Ansatz untersucht die Lebenssituation und die subjektiv wahrgenommenen sozialen Einschränkungen der ehemals leprakranken Bewohner unter Anwendung quantitativer und qualitativer Methoden. Zur sozio-demographischen und klinischen Charakterisierung der ehemals leprakranken Bewohner wurden selbstentwickelte Frage- und Dokumentationsbögen eingesetzt. Die subjektiven sozialen Einschränkungen wurden mittels der Partizipations-Skala (P-Skala, van Brakel 2006) quantifiziert. Durch Fokusgruppendiskussionen wurden für die Betroffenen relevante Themen und Konflikte erfasst. Die 90 ehemaligen Leprakranken waren bedeutend älter als die 86 nicht von Lepra betroffenen Bewohner des CCAD (Median: 64,5 bzw. 16,0 Jahre, p < 0,001). Zwei Drittel der ehemaligen Leprakranken lebten in Häusern, ein Drittel in Pflegeunterkünften auf dem von einer Mauer umgebenen Gelände. Alle waren von der Lepra geheilt. Da die meisten Befragten eine staatliche Rente erhielten, stand ihnen mehr Geld zur Verfügung als dem durchschnittlichen Einwohner Cearás. Die Schulbildung war sehr niedrig, was der allgemein schlechten Bildungslage älterer Menschen Cearás entsprach. Ein Drittel der Befragten hatte keinen Kontakt zur Familie außerhalb des CCAD. Die ehemaligen Leprakranken zeigten in 72,7% sichtbare körperliche Folgen der Lepra. Bei der Anwendung der P-Skala wiesen 51,9% eine subjektive Partizipationseinschränkung auf (P-Index > 12), die Hauptprobleme lagen in den Bereichen Arbeit, Mobilität und soziale Aktivitäten. Positiv korreliert mit dem P-Index waren: Stärke und Anzahl der sichtbaren körperlichen Veränderungen (p = 0,001), der Aufenthalt in einer Pflegeunterkunft (p = 0,001), der Zeitpunkt der Diagnose vor 1982 (p = 0,002) und kein regelmäßiger Besuchsempfang (p = 0,004). Alter, Geschlecht, Einkommen, Partnerschaft und Aufenthaltsdauer im CCAD korrelierten nicht signifikant mit dem P-Index. In den Fokusgruppeninterviews mit 17 ehemals leprakranken Bewohnern wurden die Gründe für das Wohnen im CCAD, Freiheit, Alltag, Familie, Stigma/Vorurteile und der Umgang mit Krankheit und Kränkung zum Teil kontrovers diskutiert. Das CCAD wurde von einigen Teilnehmern als Schutz- und Ruheraum vor einer bedrohlichen Außenwelt angesehen, während andere die Langeweile beklagten und sich mehr Aktivität und Kontakt mit Außenstehenden wünschten. Der Zugewinn an Freiheit nach Öffnung der Einrichtung wurde dem Verlust von Sicherheit gegenüber gestellt. Einerseits wurden der Erhalt einer Rente, die kostenlose Unterkunft und medizinische Versorgung als Vorteile gegenüber der Normalbevölkerung gesehen. Andererseits wurden gesellschaftliche Vorurteile und Benachteiligungen, z.B. bei der Arbeitssuche, hervorgehoben. An emotionalen Reaktionen auf Diskriminierungen wurden Resignation, Wut und Verzweiflung geäußert. Die Interviews zeigten eine ablehnende Haltung gegenüber der Verwaltung bei gleichzeitiger Abhängigkeit im Sinne einer paternalistischen Beziehung. Der Umgang mit Stigmatisierungen in der Öffentlichkeit reichte von sozialem Rückzug und Täuschung bis zu offenem, selbstbewussten Auftreten. Nach der Exklusion aus den primären Familienstrukturen haben viele Bewohner im CCAD neue Familien gegründet. Die starke Identifikation mit der Einrichtung und die deutliche Aufteilung in „hier drinnen“ und „da draußen“ zeigte, dass eine Integration trotz Öffnung des CCAD und Zuzug von Familienangehörigen für viele Bewohner nicht statt gefunden hatte. Maßnahmen zur Rehabilitation sollten verstärkt in den Bereichen Arbeit, Mobilität und soziale Aktivitäten implementiert werden. Das Gefühl, innerhalb der Gemeinschaft respektiert zu werden, lässt auf ein gutes Potenzial zur Selbstorganisation und Selbstbehauptung der Betroffenen schließen, worin die Bewohner im Sinne des Empowerments zu unterstützen sind. Bereits bestehende Strukturen wie MORHAN und die Bewohnerversammlung können einen geeigneten Rahmen bieten. Insgesamt zeigt die vorliegende Studie, dass die Lepra auch lange nach Heilung für die Bewohner des CCAD noch ein bestimmendes Element ihres Lebens ist. Die Krankheit hat nicht nur ihre Biographie verändert, sie bewirkt noch bis heute Einschränkungen im gesellschaftlichen Leben und ist das verbindende Element der engeren Bezugsgruppe. Im Sinne der Gesundheitsdefinition der WHO muss die soziale Rehabilitation der Bewohner ehemaliger Leprakolonien als wichtiger Teil der Therapie angesehen werden.Many diseases lead to social exclusion – but one is even used as a metaphor for isolation: leprosy. This infectious disease provoked by Mycobacterium leprae may – if not treated in early stage – cause strongly stigmatizing alterations of the face and extremities. Therefore, social consequences of leprosy should be considered as important as the physical condition. The isolation of leprosy patients was already stipulated in the Old Testament – in Brazil it was dictated by law until 1962. Some of the former leprosy colonies are still inhabited today. One of these institutions is the “Center of Living together” (CCAD) inaugurated in 1928 in the Brazilian state Ceará, although the residents are free to leave the center since 1981. So far, a structured investigation on life circumstances and social exclusion of the inhabitants of former leprosy colonies in Brazil does not exist. This study with interdisciplinary approach explores life situation and perceived social exclusion of the persons affected by leprosy living in the former leprosy colony by use of quantitative and qualitative methods. To characterize the inhabitants of the CCAD, socio-demographic questionnaires and clinical documentation sheets were applied. Social restriction was measured with the Participation Scale (P-Scale). Relevant life aspects and conflicts were grasped in Focus Group Discussions (FGD). The 90 former leprosy patients in the CCAD were by far older than the 86 non-leprosy-affected residents (median: 64.5 years vs. 16 years, p<0.001). Two third of the former patients lived in little houses and one third in the nursery homes on the grounds of the CCAD. At the time of the study, there was no active case of leprosy in the CCAD. Questionnaire data was obtained from 77 out of the 90 former leprosy patients. As most of them received a state pension, they were not considered poor compared to the population of Ceará. One third of the interviewees had no contact with family members outside the CCAD. Visible physical alterations were documented in 72.7% of the study participants. The P-Scale showed a significant level of social participation restriction in more than half of the persons. The main problems were found in the areas of work, mobility and social activities. The score of the P-Scale (P-Index) was significantly correlated with the severity of physical alterations (p = 0.001), residency in a nursery unit (p = 0.001), time of diagnosis before 1982 (p = 0.002) and receiving no visitors (p = 0.004). Age, sex, income, having a partner and time of residency in the CCAD were not significantly correlated with social restriction. The 17 participants of the FGD discussed motives for living in the CCAD, freedom, every-day life, stigmatization/prejudice and coping with the consequences of the disease. The CCAD was seen as a safe and quiet place by some, while others criticized boredom and expressed the wish for more activity and contact with persons from outside. On one hand, free housing, pension and medical care were named as advantages compared to the “normal” population, on the other hand the participants reported experiences of prejudice and social discrimination. Emotional reactions to humiliation in society included anger, resignation and despair. The interviews showed rejection of the administration personnel with concurrent dependence in the sense of a paternalistic relationship. Coping with stigmatization in public ranged from deception or social withdrawal to open, self-assured behavior. After having been excluded from original family structures, many inhabitants founded new families inside the CCAD. The strong identification with the institution and the clear categories of “us inside” and “those outside” shows that reintegration into society has not been fully successful yet. Rehabilitation measures should be implemented especially in the areas work, mobility and social activities. The feeling of the residents to be respected in the closer community reveals a good potential for self-organization that should be supported in the sense of empowerment. Already existing structures like MORHAN (Movement for the reintegration of leprosy-affected persons) and the regular residents´ meetings could serve as a base for reintegration. On the whole, the study shows that despite cure leprosy is a dominant life theme for the residents of the CCAD. The disease not only changed their biography and shaped their identity but also still causes restriction in social life and is the linking element of the closer community. In sense of the definition of health by the WHO, social rehabilitation of the inhabitants of former leprosy colonies must be seen as an important part of therapy

Prevalence and risk factors associated with pediculosis capitis in an impoverished urban community in Lima, Peru

Background: Pediculosis capitis is a ubiquitous parasitic skin disease associated with intense pruritus of the scalp. In developing countries it frequently affects children and adults, but epidemiological data at the community level are rare. Objectives: To assess prevalence and risk factors associated with pediculosis capitis in a resource-poor community in Lima, Peru. Materials and Methods: In total, 736 persons living in 199 households in a circumscribed neighbourhood were examined for head lice and nits by visual inspection. At the same time, socio-demographic data were collected using a structured questionnaire. Variables associated with pediculosis were identified by performing a bivariate analysis, followed by a multivariate logistic regression analysis. Results: Prevalence of pediculosis capitis was 9.1% (95% confidence interval (CI): 7.0-11.2 %) in the general population and 19.9% (CI: 15.4-24.4%) in children ≤15 years of age. Multivariate analysis showed that pediculosis capitis was significantly associated with age ≤ 15 years (OR: 16.85; CI:7.42-38.24), female sex (OR: 2.84; CI: 1.58-5.12), household size of >4 persons (OR: 1.98; CI: 1.11-3.55), low quality of house construction material (OR:2.22; CI: 1.20-4.12), and presence of animals in the household (OR: 1.94; CI: 1.11-3.39). Conclusion: Pediculosis capitis was a very common disease in the studied community in Lima, Peru. Our logistic regression analysis affirms that young age is the most important risk factor for pediculosis capitis. Moreover, female sex, large household size, living in wooden houses and the presence of animals were identified as being significantly associated with head lice infestation

Perceived social restriction in leprosy-affected inhabitants of a former leprosy colony in northeast Brazil

INTRODUCTION: In Brazil, isolation of individuals affected with leprosy was compulsory by law from 1920 to 1962, but in reality, confinement of patients to leprosaria continued until the 1980s. The social participation restriction of people still living in these institutions has never been investigated systematically.\ud \ud STUDY AIM: To examine the extent and type of participation restriction perceived by former leprosy patients living in the Centro de Convivência Antônio Diogo (CCAD), a previous leprosy colony in rural Northeast Brazil, by using the Participation Scale.\ud \ud RESULTS: Forty (51-9%) out of 77 individuals reported significant participation restrictions, mainly related to work and mobility. Perceived participation restriction was significantly higher in people living in nursing units of the CCAD (P = 0-001), if diagnosis of leprosy was made before 1982 (P = 0.002), in the presence of walking limitation (P < 0.001) and visible physical alterations (P = 0-002), such as foot deformities (P = 0.002), saddle nose (P = 0.03) and blindness (P = 0.04), and in those individuals who did not receive visitors (P = 0.004).\ud \ud CONCLUSION: Social rehabilitation, especially in the areas of work and mobility, is strongly needed together with prevention of debilitating physical sequelae and reduction of stigmatisation

A forum on the Zika virus

Luciana Brondi – ORCID: 0000-0001-6221-4440 https://orcid.org/0000-0001-6221-4440Item not available in this repository.http://somatosphere.net/2016/a-forum-on-the-zika-virus.html

Epidemiology and morbidity of hookworm-related cutaneous larva migrans (HrCLM): Results of a cohort study over a period of six months in a resource-poor community in Manaus, Brazil.

BACKGROUND:Hookworm-related cutaneous larva migrans (HrCLM) is a neglected parasitic skin disease, widespread in resource-poor communities in tropical and subtropical countries. Incidence and risk factors have never been investigated in a cohort study. METHODOLOGY/PRINCIPAL FINDINGS:To understand the seasonal epidemiology of HrCLM, an open cohort of 476 children in a resource-poor community in Manaus, Brazil was examined for HrCLM monthly over a period of 6 months. Monthly prevalence and intensity of infection were correlated with the amount of monthly precipitation. Multivariable Cox regression analysis indicated male sex (hazard ratio [HR] 3.29; 95% confidence interval [CI] 1.95-5.56), walking barefoot on sandy ground (HR 2.30; 95% CI 1.03-5.16), poverty (HR 2.13; 95% CI 1.09-4.17) and age between 10 and 14 years (HR 1.87; 95% CI 1.01-3.46) as predictors of HrCLM. Monthly incidence rates ranged between 0.21 and 1.05 cases per person-year with an overall incidence of 0.52 per person-year. CONCLUSIONS/SIGNIFICANCE:HrCLM is a frequent parasitic skin disease in this resource-poor community. Every second child theoretically becomes infected during one year. Boys, 10 to 14 years old, belonging to the poorest households of the community, are the most vulnerable population group. Even in the tropical monsoonal climate of Amazonia there is a considerable seasonal variation with monthly incidence and number of lesions peaking in the rainy season

Correlation between the number of affected areas and impairment of skin disease-associated life quality (rho = 0.36; p = 0.004).

<p>Correlation between the number of affected areas and impairment of skin disease-associated life quality (rho = 0.36; p = 0.004).</p