Sunday, March 29, 2009

Agency in seeking health!!

The first question I want to raise is that "does pluralism means agency"?  
Meyer's makes a substantive point with his poignant account of Beverly. Quoting him, "the ground upon which chronic illness is made meaningful becomes profoundly unstable when the conditions of experience fail to conform to standard disease categories and their symptomatology." We have come across this thread in previous readings too when we have seen biomedicine being applied and experience reduced to "measurable", "diagnosable" categories.  The other question is what else to do and how to reconcile? In today's world, when movements constantly take people across borders and translational locations, where people exercise their agency (do they?) to get into stultifying systems...what are the options to negotiate health? How do they then exercise agency? Beverly exerts agency when she decides not to apply for social security benefits as then she might be judged incapable of keeping her grandchildren; she constantly takes decisions in her complex treatment seeking route through the emergency wards of different county hospitals, when she cleans up when the "black" social worker is visiting her. But again, is this decision making the same as exercising agency?
Becker talks about the uninsured in the US health care system and possibilities of containment, ghettoization. This is a very critical area of study and which greatly impacts health and related areas of housing, education. The sad irony, is all of us tacitly approve of it; the system asks us to. For example, in our No.1 health communication program in US at Purdue, there is hardly any research which looks are the uninsured or the role of insurance industry in impacting the health of people here. Becker's account confirms that the vulnerable are to be exploited at every step and that to be a underprivileged like the uninsured means that you continually face an assault on your dignity, are discriminated, depersonalised when accessing the health care system. 

Steph, is this the same in Germany; what about Bangladesh, Raihan; Nadine could tell us about Lebanon and Mohan what does your experience say?

Boyce talks about the related pigeonholing approach in biomedicine in talking about gays and MSMs. It was a revealation for me as I also articulated "Kothis" and "panthis" and had not gone into these analytical thinking. It is very important for us to reflect on the constructions of MSM sexuality when we design and implement HIV/AIDS campaign. Tough though!! Its easy to reflect on a paper but as a implementer on the field, its a totally different ballgame!!

Kim, Zhang, Wayland, Ugent, Arakelova again discuss the importance of taking a constitutive approach, a pluralistic approach in curing and healing and interacting with patient populations. There is also the running thread of questions on epistemology and the different cosmology that people have access to. And power dictates the way positions are chosen, knowledge claims are made. Quoting Wayland, "the situational valuation of local and scientific plant knowledge related to the different relationships of power in which physicians find themselves in each context." He further writes, "as individuals participate in the politics of knowledge, context and identity shape the strategies they chose." Further, with the dissapearing knowledge in these new configurations of power, contexts and identity which themeselves are in flux, it is important as Ugent says to document the old traditional medicinal/ herbal practices/ systems. It is heartening to note that as I write this there are many civil society organizations in different parts of the world who are documenting the invaluable practices of the dissapearing old but they do need more resources and focus. 

Zhang described how the Chinese patients chose not to take Viagra and the medics chose not to prescribe Viagra in the company reccommended doses and how they mixed the TCM with the Viagra. This is a very familiar story for me in India. I also treat myself with both homeopathic medicines and allopathic medicines when I need them (despite the admonitions of my grandmother that both reduce each others' efficacy!!, she was  homeopath!). But when pharma companies keep on branding each TCM or herbal or Indian traditional plant/ extract/ substance/ molecule, patent it and market it, where does our agency go? (Refer Ginseng, Turmeric etc..).

So, what is agency? and is the definition dependent on context and the epistemology?

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