How do doctors impute adverse drug reactions (ADRs)? This operation, neither obvious nor natural, involves relevant health issues, particularly the report to the Adverse Drug Reporting System. No imputation implies no reporting and therefore, no drug control for the general population. Based on data from a qualitative research on medical management of ADRs in general medicine and oncology, this article points to how practitioners impute (or not) a reaction to a drug and the complex ways in which they recognize it or avoid it. After a description of collective and individual issues of the imputation process, the results of the study show the subtle or diverted forms in which ADRs are expressed: expected effects, drug toxicity or patient intolerance? How can doctors dare to express such an incertitude?
Concerns about antiretroviral drug stock shortages and their consequences in terms of biological resistance to HIV treatment have gone relatively unnoticed until recently. Indeed, these problems that have recently taken a more important place in global health policies, have been put in the background of an international agenda since 2009 upheld by a global and voluntarist vision of the eradication of the disease and the achievement of "a world without AIDS" by 2030. The failure of antiretroviral therapies in resource-poor countries is even now described as the "fourth epidemic". While technical expertise is needed to understand these shortages and resistances to deal with them, a broader anthropological perspective allows to conceive them as the side effects of the massification of antiretroviral treatments involving intertwined intimate, biological and social dimensions. By proposing an ethnography of treatment failures in the Central African Republic, this article examines the biological, individual, social and political effects of a "pharmaceutical insecurity", experienced in many African settings, which constitutes the counterpart of the biological and political promises generated by mass treatments.
This article is based on a corpus of data collected in Antananarivo, the capital of Madagascar, between April and August 2015. The aim of this paper is to analyze the social conditions of production of self-medication for young children and the management of frequent and benign infant ailments. In this article, we question the use of private and informal actors in the sale of pharmaceutical drugs, the methods of acquisition and use, in light of popular knowledge about drugs. Our results show that pharmaceuticals are central in the therapeutic practices of Tananarivians. In the daily management of illnesses, choices are based on a pragmatic desire to heal at lower costs. The management of early childhood illnesses differs from adult care practices which are predominantly characterized by self-consumption of medicines. This article sheds light on the specificities of child care practices, which crystallize at the same time representations about child health and distrust towards certain pharmaceutical products.
This article seeks to understand the scientific and medical construction of the notion of “frailty” of old persons. For this purpose, it relies on the analysis of a body of medical literature, conducted between July and August 2016, and field data of an exploratory survey of health professionals working around frailty. First, the text proposes a sociohistorical contextualization in order to understand the emergence of the category of “frailty” in the field of geriatrics and French public health. Then, we examine the question of the inclusion of the category of “frailty” in a broader process of medicalization of aging. The data nevertheless reveals nuances in the use of the category of “frailty”, showing that two distinct processes can be identified: one, which could called healthicization, and a second, triggering the biomedicalization of old age. These two processes imply not only different scientific postures but also actors and particular care for frailty.
Many children in Brazil benefit from a pluralism of healthcare practices, administrated daily for prophylactic or healing purposes by different actors. Children are the main concern of community health workers, who are the main actors of the Family Health Program’s public policy. Mothers and grandmothers are also involved in daily care, providing different forms of medication and food practices. Finally, children are frequently blessed at home by specialists of body and spirit troubles, or by their mothers, in order to heal afflictions and to give them a spiritual protection. Based on an ethnography carried out in the Central-West region of Brazil and from the results of a finalized research, the study of these heterogeneous remedies highlights their inscription in spaces of proximity, some emic nosological categories specific to childcare, and local conceptions of children’s bodies. The analysis of local relational and spatial dynamics is key to understanding the underlying logic behind these forms of care. Their arrangement varies depending on several factors: inter-generational relationships, strategies of power and legitimacy, including the religious universes in which such practices are present. Such an arrangement produces caseiro care, specific to the therapeutic space woven between the streets and the houses of the neighborhoods. Based on an ethnographic approach and on the heuristic reach of an emic category, this paper questions and complexifies the association between the daily care given to children and the domestic sphere of social life.
This article presents a complex path of care. A child is being treated for hydrocephalus in a cave where supernatural entities provide care in the countryside surrounding the capital of the Betsileo region in the Central Highlands of Madagascar. The child and his parents live for free in the cave manager’s hamlet, surrounded by other patients being treated. However, the path is long. The family determines which therapists to consult and the causalities of the suffering. This reveals transformations in the cultural, therapeutic and religious models. This case sheds light on the difficulties of accessing paediatric care, but also more generally biomedical care in the rural areas of Madagascar and consequently on the possibilities of the diviner-soothsayers to forge their reputation (both magico-religious and medical).
This paper deals with the links between health problems and trajectories. Analyzing the example of children diagnosed with ADHD, it underlines the role of the diagnostic quests, i.e. the efforts to find sense and solutions that the young people and their relatives produce to cope with their difficulties. Those quests can follow various directions because they are influenced not only by past social characteristics and trajectories (gender, social class, kinship configuration…) but also by present issues which require daily arrangements and decisions for the future (in terms of schooling, education, treatment…). Our 45 interviews with children and/or relatives highlight the factors of these variations, which appear to be particularly numerous and complex, but which give tools to analyze many other confrontations with health problems.
The link between children’s and parents’ care trajectories and life stories is the focus of this article. Based on my fieldwork carried out in a public hospital children’s psychiatric ward and in families’ home, I question social skill learning conditions at hospital, and these skills’ transferability at home. Articulating my research focus on biomedical, complementary and domestic activities, I shed light on the logics and practices of care implemented by children, parents and health workers or healers. From 2013 to 2015, I spent daily moments observing, discussing and living with families, and I therefore propose that parent and children biographic trajectories enable the transferability of skills and the improvement of suffering situations.
In France, profound changes have emerged in the approach to diseases and disabilities in a context of promoting the subjective rights of users and more broadly principles of health and social “democracy”. The place of families of children with disabilities in the development and implementation of intervention projects concerning their children has acquired an institutional legitimacy in the new legislative framework of the medico-social sector, especially through the concept of “life-project”. The traditional asymmetry between professionals and users is thus reduced. We make the hypothesis that parental activity will become more socially visible. The article draws on some of the results of a research aimed at highlighting the joint reconfigurations of the work of monitoring the pathways of young people with disabilities by families and professionals. We are interested here in the family aspect of this redefinition by restoring the place and the work of the families in the educational and therapeutic course of their child in situation of handicap.
Africa has the highest infant mortality rate in the world. However, the quality of hospital care for children there has rarely been studied. This qualitative research, conducted in a pediatric unit in Dakar (Senegal), analyzes the silence of medical professionals and conflicts among children with cancer, their families and such professionals concerning the communication of information about their disease and the end of life. Despite protocol and parents’ requests, doctors often do not inform parents of their child’s diagnosis and prognosis, citing their inability to comprehend medical explanations and the need to protect them from psychological trauma. In conclusion, doctors remain silent in order to avoid facing the reactions of the parents who would learn of the gravity of their child’s condition. Two types of reasoning are at work in this situation: a highly hierarchical doctor–patient/family relationship and the non-recognition of death in the medicine of Dakar.
Little is known in social science about illicit drug users’ perspective on the therapeutic dimension of substance use. Based on a qualitative study, this article examines drug users’ self-medication practices, and the attitude of general practitioners towards them. The availability of opioid substitution treatments on the black market allows people to use them to self-medicate heroin withdrawal symptoms. Drug users also use a wide range of substances in order to relieve common health problems (e.g., flu, pain, or anxiety). Through self-experimentation and peer-to-peer exchange, they develop experiential knowledge about substances, created and transmitted within the social world of illicit drugs. But this knowledge is not always recognized as such by physicians who often interpret drug users’ self-medication practices as misuse or non-compliance.
Dyslexia and dyspraxia, cognitive disabilities and new school failure classifications are categories that unsettle the division of labor between those treating schooling difficulties. Doctors, psychologists and teachers fight over pedagogical expertise. And so do parents, in their role as "partners" in the support schemes. They witness the progress of their own position within measures for "dys" children. Mothers, in particular, are prime targets at the very heart of these paths, managing coordination issues between various professionals. They may also be “victims” of territorial power struggles. In order to be scholastically rewarding, every scheme requires a definite maternal commitment, and notably free time. These mothers may choose to work less or stop working altogether. Faced with the best interest of the child, these sacrificed professional lives are seldom mentioned, either publicly or in sociological research works.
In this article based on qualitative research on home hospitalization carried out in the Lorraine area of France, we discuss two aspects of end of life care at home. The first is defined and formalized institutionally and takes the form of palliative care whose objective is to render death common-place by incorporating it into the household and its routines. The family and household are solicited as partners in this delegation of biopolicy. Another less formalized activity, for which paramedical staff, volunteers, and the family are more directly responsible, is thanatic work. This consolidates the status of the person as “dying” requiring specific precautions. Far from being mutually exclusive, these two types of practices can coexist, overlapping or appearing successively in the course of the life-end trajectory. Seen from this angle, palliative action and thanatic action are conceived as spatial, bodily and relational procedures which shape the ontology of the dying person whose status oscillates between the “same yet transformed” and the “exceptional body”. These two types of action also function as social chronometers marking the passing of time during the turbulent and uncertain end of life course.
Forensic examinations on minors are a borderline case of forensic expertise because they destabilise the care/record dichotomy according to which therapeutic work must disappear behind the expertise of assaulted bodies. This paediatric expertise brings to the forefront a defining debate in forensic medicine around the choice of those having mandate to carry out acts on judicial requisitions. Paediatricians consider that they should have a voice when the handling of children requires care and screening. Claiming a paediatric prism, forensic paediatricians accuse the requisitions of limiting forensic operations to simple acts of constat, while their expertise is also that of paediatric specialists of children. By placing "children first", they intend to deal with specifically paediatric problems without reducing the examinations of minors to the level of expertise alone. Based on an ethnographic survey of these professionals, the article shows that paediatric specialty training has a strong impact on the practice of forensic expertise of minors, constraining forensic work between a requirement for evidence and a therapeutic concern.