Abstracts 22 ( 1 )


Beyond impediments to caring: Toward a morality of late-life care

A primary caregiver’s responsibility to arrange late-life care can be challenging in light of the various obstacles confronted in different kinds of care settings and care giving arrangements. Using examples from nursing home care, a foster home, and home care, this article describes particular constraints imposed on formal caregivers that compromise their imperative to care. Drawing from observations of caregivers who circumvented these obstacles and from the dialogical ethics of Buber and Levinas, the article briefly considers the requirements for a morality of late life caregiving.

[end-of-life care, morality of care, care ethics, dementia care, nursing homes, foster homes, home care]

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Proximity and distance in palliative care from the perspective of primary caregiver

Caregiving which addresses a situation of serious illness at home is an interpersonal experience for the sick person, health professionals and family members. Before I go into a discussion about what constitutes ‘good care’ in this setting, my aim is to understand the boundary disturbances and tensions observed as primary caregiver in the relationship between professional caregivers and my lifelong partner. In the search for models, concepts and theories for clarification, this contribution bears witness to both painful and rich personal experiences. The power of negative images regarding a life worth living will be set against the grief of losing autonomy and the compelling need to live a self-determined life.

[palliative care, end-of-life care, home health care, family, network, professional caregiver, quality of life, amyotrophic lateral sclerosis, ALS, Switzerland]

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“There is somebody in heaven who takes care of you!”
Nursing care and religiosity on a hospital ward in Ghana

Looking at care delivery in hospital settings worldwide, it is the work of nurses that appears most prominent. While this is true in a general sense, it is important to realize the impact of cultural norms and social perceptions on the variety and differences in care giving. This paper explores the notion of care and religion on a medical ward in a Ghanaian teaching hospital. Analyzing the daily routine on the ward, it shows how medical nurses deal with the challenges put before them and how religion must be considered as an important element of the working routine in understanding the notion of care in the hospital setting. Both nurses–and patients subscribe to a set of cultural norms; they base their expectations and decisions on a mixture of professional formation, traditional heritage and individual background. Since the beginning of nursing in Ghana, the Christian belief influenced and transported a certain image of the nurse and woman in general. Religion plays an important role; it shapes perspectives, offers possible reactions to disease and death and influences social behaviour. This paper shows that the hospital is not a culturally-neutral biomedical institution but embedded in the Ghanaian culture. It is a place of medical treatment, social encounter and defined rituals.

[care, religion, nurses, hospital, Ghana]

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Caring for people in their ‘third age’
Normative and actual care arrangements for the elderly in Kalavrita, Greece

For Greek people, the ideal way of living their ‘third age’ is to stay in their own house and, if they become dependent, have children around to take care of their needs. Nowadays, many families cannot adhere to this norm because children’s work obligations mean they either do not have time or are physically not around. Public institutional care for the elderly is scarce, and children do not want their parents there as it is a sign of their inability to care for them. Some families solve the ‘problem’ by hiring migrant women from Eastern Europe as relatively cheap live-in caregivers, while the few homes for the elderly founded by the Greek Orthodox Church have a better reputation than those of the government. This paper presents the findings of an exploratory study of the developments in care arrangements for the elderly in Kalavrita, a small town on the Peloponnesus, and of the views of the elderly, their children, and caregivers.

[care arrangements, elderly, stakeholders in care, Greece]

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“Why should I eat shit?”
Negotiating the ‘dirty work’ of taking care of elders on an Aegean island

This article examines the ways that the informal, at-home care of frail elders is negotiated in families living on a small Greek island in the Aegean. Local terms of reference for various levels of care carry meanings of expectations for how family members, or even outsiders, should be involved. Pivotal points in the decisions of younger family members to provide hands-on-care for their parents and other elder relatives include a reconciliation of obligations to return their economic, social and emotional support and take into account cross-generational reciprocity in the form of property transactions. Meeting these expectations accumulates social and symbolic capital and preserves the family’s honour and good name on the island. Middle-aged women are usually the ones who are called upon to provide care and to protect the family’s interests; consequently they are continually balancing the care of elders and of children.

[elderly care, ageing, family relations, ethnography, reciprocity, social capital, Greece]

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Care as a turning point in sociotherapy:
Remaking the moral world in post-genocide Rwanda

Community-based sociotherapy was introduced in Rwanda in 2005 in order to contribute to the healing of social worlds that were severely damaged by war and genocide. People who participate in sociotherapy perceive this intervention as medicine for their troubled hearts. Each sociotherapy group, averaging twelve people, holds fifteen weekly meetings. Two facilitators guide the group through six different phases: safety, trust, care, respect, new rules, and memory. It is mostly during the care phase that a substantial part of the participants experience a change in their lives, which is the beginning of the reparation of their morally shattered social world and, subsequently, the reconstruction of social capital in its entirety. The analysis of this process is based on qualitative research about the practice of sociotherapy and its impact on the communities where it is practiced.

[Rwanda, genocide, social disconnection, sociotherapy, moral world, care]

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Gender-based violence and women’s search for care in Mozambique

In Mozambique, beating women is often thought of as an expression of love and care of men towards their women partners. This perception contrast starkly with the concept of care as a form of protection of women expressed in the context of human rights discourse. The contradictions in perceptions of the meaning of care and respect are based on sociocultural traditions that create obstacles to address the serious problems of women caused by gender-based violence. In this article I elaborate on the results of an anthropological study on the impact of a community-based psychosocial support program in Southern Mozambique and discuss the different features of care for women, searching for protection and support in life. Based on my findings, I argue that the provision of care for real needs turns out to be the most important factor that gives roots to the concept of women’s rights for women who are exposed to gender-based violence.

[care, culture, gender-based violence, women’s rights, psychosocial support, Mozambique]

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“If we sympathise with them, they’ll relax”
Fear/respect and medical care in a Kenyan hospital

In a resource-poor Kenyan hospital, relationships produced within medical encounters echoed particular kinds of caring relationships within families. Often, medical care correlated not to love or closeness but rather luoro, a Luo term meaning both fear and respect. Luoro is also the appropriate orientation for children towards parents, teachers and other adults. Within luoro relationships medical staff and patients were both understood as responsible agents in the production of care. Through luoro, nurses and clinicians imagined patients would behave ‘properly’ and thus be able to receive care. This was particularly true in the case of the labour room, where closeness, understood as ‘being relaxed’, was seen as a potential inhibitor in the successful provision and receipt of care. However, in other contexts within the hospital a more egalitarian ‘relaxed’ care was a feature of medical care. In theorising care, a common analytical device has been to divide care, for example comparing ‘emotional’ and ‘technical’ aspects of care or ‘caring-for’ with ‘caring-about’. My argument in this paper is that an alternate analytic is one of care as practice. An ethnographic focus on practices of care in this Kenyan hospital suggests that it may be helpful to think about care in health care as consisting of divergent sets of caring practices which cut across boundaries such as technical/emotional.

[care, health care, hospital, nurses, labour, fear, respect, Western Kenya, Luo]

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Caring devices: About warmth, coldness and ‘fit’

Healthcare technologies are often put in opposition to warm human care and contact. This paper explores the assumed coldness of medical technologies by presenting the case of a technology that is experienced as particularly caring by the patients using them. This is a device to support terminal oncology patients at home. The analysis shows that this device provides care that can indeed be called ‘warm’. However, warmth in itself is not enough for characterising a good professional – or technological – caring relation, because the metaphor downplays the importance of clinical knowledge. The heat metaphors and their opposition do not hold when analysing actual care practices. A third metaphor for good care is proposed where, rather than establishing an ethical (warm) relation of subjectification with patients, or an epistemological (cold) relation of objectification of their bodies, can be described in terms of an ‘aesthetics of fit’ between the carers’ and devices’ interventions and the situation of individual patients.

[palliative care, oncology, healthcare technology, health buddy (HB), telecare, home, warm care, good care, aesthetics]

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Other articles / Overige artikelen

Goodness! The empirical turn in health care ethics

This paper is intended to encourage scholars to submit papers for a symposium and the next special issue of Medische Antropologie which will be on empirical studies of normative questions. We describe the ‘empirical turn’ in medical ethics. Medical ethics and bioethics in general have witnessed a move from applied ethics (the application of rules and principles to complex situations) to a renewed interest in practical, everyday ethical issues and the ways health care providers deal with them in practice. We highlight four forms of empirical research in ethics: studies about the effects of some form of institutionalized ethics in health care; studies about ethical views and practices in society; studies about ethical issues concerning medical innovations, and finally, studies about the normativity of care practices. We end the paper with an assessment of the function of empirical ethics research: to provide the building blocks for societal debate about health care.

[empirical ethics, medical ethics, health care, ethnography, anthropology]

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