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Sandesara U. Striving Against Sonlessness: The Moral Uses of Medical Pluralism in Western Indian Quests for a Boy. Cult Med Psychiatry 2024:10.1007/s11013-024-09880-6. [PMID: 39320589 DOI: 10.1007/s11013-024-09880-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2024] [Indexed: 09/26/2024]
Abstract
Amid patriarchal conditions that render one son necessary and multiple daughters burdensome, selective abortion of female fetuses has become pervasive in India. Public responses often cast sex selection as self-evidently ignorant, cruel, and misogynistic - an obvious evil meriting denunciation and eradication. Drawing on ethnographic fieldwork in Gujarat state, this article zooms out from ultrasound and abortion to survey the landscape of biomedical, herbal, and religious son production techniques surrounding them. Doing so clarifies the lived moral experience in which sex selection is embedded. Resort to multiple son production techniques is both an abstract moral indicator reflecting prevailing concerns and a pragmatic moral intervention aimed at harnessing every available means in response to those concerns. Fundamentally, people live out the multimodal quest that sometimes leads to selective abortion as aspiration - social, bodily, spiritual - toward an indispensable good, not as heartless rejection of daughters. Pluralistic son production illuminates the moral uses of medical pluralism for care-seekers, social scientists, and policymakers and practitioners. The case underscores that "complementary" therapies, rather than being just desperate behaviors, barriers to biomedical therapy, or curiosities to be integrated into care, may in fact be the clearest markers of the moral conditions in which public health problems unfold.
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Affiliation(s)
- Utpal Sandesara
- General Internal Medicine (School of Medicine) and Global Health (International Institute), University of California - Los Angeles, 1100 Glendon Avenue, Suite 900-912, Los Angeles, CA, USA.
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2
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Camara H, Nosi S, Munnull G, Badman SG, Bolgna J, Kuk J, Mola GD, Guy R, Vallely AJ, Kelly-Hanku A. "This is really something: same place, same day result, same day treatment" women's experiences of testing positive for HPV and receiving same-day treatment in Papua New Guinea: an interpretative phenomenological analysis. BMC Womens Health 2023; 23:438. [PMID: 37596636 PMCID: PMC10439555 DOI: 10.1186/s12905-023-02557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/19/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) testing is transforming cervical screening globally. The World Health Organization (WHO) now recommends same-day HPV screen-and-treat for primary cervical screening in low- and middle-income countries (LMIC) but there is a lack of evidence on women's lived experience of testing positive for oncogenic HPV and receiving same-day treatment. This study aimed to address this knowledge gap among women participating in a same-day HPV screen-and-treat (HPV S&T) program in Papua New Guinea. METHODS As part of a larger qualitative study, this paper explores the lived experiences of 26 women who tested positive for oncogenic HPV and were treated the same day. We analysed the data using the interpretative phenomenological analysis method. All data were managed using Nvivo 12.5. RESULTS The interpretative phenomenological analysis led to three superordinate themes: 1) facing and alleviating initial worries, (2) transforming the disclosure process, and (3) connecting to their faith. Women's experiences of the same day HPV screen-and-treat were framed by initial emotional reactions to their positive HPV test result, and having access to treatment on the same day, which helped address their worries and fears, and transformed their experience of disclosing their test result and subsequent treatment to family and friends. CONCLUSION This study shows that, while women experience similar initial emotional reactions, undergoing same day treatment quickly resolved the women's worries, making this program highly acceptable. Overall, women's engagement in the program confirmed its high acceptability and cultural congruence, leaving women feeling empowered and hopeful about their future, and the future of all Papua New Guinea women.
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Affiliation(s)
- Hawa Camara
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia.
| | - Somu Nosi
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Gloria Munnull
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
- Department of Obstetrics & Gynaecology, Mt Hagen Provincial Hospital, WHP 281, PO Box 36, Mt Hagen, Papua New Guinea
| | - Steven G Badman
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - John Bolgna
- Department of Obstetrics & Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Joseph Kuk
- Department of Obstetrics & Gynaecology, Mt Hagen Provincial Hospital, WHP 281, PO Box 36, Mt Hagen, Papua New Guinea
| | - Glen Dl Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, NCD, PO Box 5623, Boroko, Papua New Guinea
| | - Rebecca Guy
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
| | - Andrew J Vallely
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW, Sydney, NSW, 2052, Australia
- Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea
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Jops P, Cowan J, Kupul M, Trumb RN, Graham SM, Bauri M, Nindil H, Bell S, Keam T, Majumdar S, Pomat W, Marais B, Marks GB, Kaldor J, Vallely A, Kelly-Hanku A. Beyond patient delay, navigating structural health system barriers to timely care and treatment in a high burden TB setting in Papua New Guinea. Glob Public Health 2023; 18:2184482. [PMID: 36883701 DOI: 10.1080/17441692.2023.2184482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Tuberculosis (TB) is a major public health issue in Papua New Guinea, with incidence rates particularly high in the South Fly District of Western Province. We present three case studies, along with additional vignettes, that were derived from interviews and focus groups carried out between July 2019 and July 2020 of people living in rural areas of the remote South Fly District depicting their challenges accessing timely TB diagnosis and care; most services within the district are only offered offshore on Daru Island. The findings detail that rather than 'patient delay' attributed to poor health seeking behaviours and inadequate knowledge of TB symptoms, many people were actively trying to navigate structural barriers hindering access to and utilisation of limited local TB services. The findings highlight a fragile and fragmented health system, a lack of attention given to primary health services, and undue financial burdens placed on people living in rural and remote areas associated with costly transportation to access functioning health services. We conclude that a person-centred and effective decentralised model of TB care as outlined in health policies is imperative for equitable access to essential health care services in Papua New Guinea.
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Affiliation(s)
- Paula Jops
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - John Cowan
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Martha Kupul
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Richard Nake Trumb
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Stephen M Graham
- Burnet Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Mathias Bauri
- Western Provincial Health Authority, Daru, Papua New Guinea
| | - Herolyn Nindil
- National TB Program, National Department of Health, Port Moresby, Papua New Guinea
| | - Stephen Bell
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Tess Keam
- Burnet Institute, Melbourne, Australia
| | - Suman Majumdar
- Burnet Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - William Pomat
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ben Marais
- Sydney Institute for Infectious Diseases (Sydney ID), University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Sydney, Australia.,Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Andrew Vallely
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- Kirby Institute, UNSW Sydney, Sydney, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
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Camara H, Nosi S, Munnull G, Badman SG, Bolgna J, Kuk J, Mola G, Guy R, Vallely AJ, Kelly-Hanku A. Women's acceptability of a self-collect HPV same-day screen-and-treat program in a high burden setting in the Pacific. BMC Health Serv Res 2022; 22:1514. [PMID: 36510192 PMCID: PMC9746197 DOI: 10.1186/s12913-022-08842-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A field trial to evaluate a self-collect point-of-care HPV screen-and-treat (HPV S&T) program was implemented in two Well Women Clinics in Papua New Guinea (Papua New Guinea). Assessing the acceptability of a health intervention is a core element of evaluation. In this study, we examined women's acceptability of both self-collection and HPV S&T intervention in Papua New Guinea. METHODS: Sixty-two semi-structured interviews were conducted with women who had undergone cervical screening in the same-day self-collected HPV screen-and-treat program in Madang and Western Highlands Provinces, Papua New Guinea. Data were thematically analysed using the Theoretical Framework of Acceptability (TFA) and managed using NVivo 12.5. RESULTS Most women agreed that self-collection was transformative: it helped circumvent the culturally embarrassing pelvic examination and increased their self-efficacy, especially due to the provision of health education, instructions, and pictorial aids. The availability of same-day results, and treatment if indicated, was particularly valued by the women because it reduced the financial and temporal burden to return to the clinic for results. It also meant they did not need to wait anxiously for long periods of time for their results. Women also appreciated the support from, and expertise of, health care workers throughout the process and spoke of trust in the HPV-DNA testing technology. Most women were willing to pay for the service to ensure its sustainability and timely scale-up throughout Papua New Guinea to support access for women in harder to reach areas. CONCLUSION This study reported very high levels of acceptability from a field trial of self-collection and HPV same-day screen-and-treat. The program was deemed culturally congruent and time efficient. This innovative cervical screening modality could be the 'solution' needed to see wider and more immediate impact and improved outcomes for women in Papua New Guinea and other high-burden, low-resource settings.
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Affiliation(s)
- Hawa Camara
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - Somu Nosi
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
| | - Gloria Munnull
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea ,Department of Obstetrics and Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Steven G. Badman
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - John Bolgna
- Department of Obstetrics and Gynaecology, Modilon General Hospital, PO Box 1200, Madang, Papua New Guinea
| | - Joseph Kuk
- Mt Hagen Provincial Hospital, PO Box 36, Mt Hagen, WHP 281 Papua New Guinea
| | - Glen Mola
- grid.412690.80000 0001 0663 0554School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, NCD Papua New Guinea
| | - Rebecca Guy
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia
| | - Andrew J. Vallely
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
| | - Angela Kelly-Hanku
- grid.1005.40000 0004 4902 0432Kirby Institute for Infection and Immunity in Society, UNSW Sydney, Wallace Wurth Building, UNSW Sydney, Kensington, NSW 2052 Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Homate Street, PO Box 60, Goroka, Eastern Highlands Province Papua New Guinea
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Kulumbu E, Munro J. Lukautim Yu Yet Gut (Take Good Care of Yourself): Moka Gomo Women Pursuing Health in Papua New Guinea. THE ASIA PACIFIC JOURNAL OF ANTHROPOLOGY 2022. [DOI: 10.1080/14442213.2022.2117843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sparke VL, MacLaren D, Esau D, West C. Exploring infection prevention and control knowledge and beliefs in the Solomon Islands using Photovoice. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000680. [PMID: 36962783 PMCID: PMC10021726 DOI: 10.1371/journal.pgph.0000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/04/2022] [Indexed: 11/30/2022]
Abstract
Healthcare associated infections are the most common complication of a person's hospital stay. Contemporary infection prevention and control programs are universally endorsed to prevent healthcare associated infections. However, western biomedical science on which contemporary infection prevention and control is based, is not the only way that staff and patients within healthcare settings understand disease causation and/or disease transmission. This results paper reports on one aspect of a study which ascertains perceptions of disease transmission and how these influence infection prevention and control practice at Atoifi Adventist Hospital Solomon Islands. Photovoice was used as the primary data collection method with staff and patients. The germ theory and hospital hygiene processes were only one of many explanations of disease transmission at the hospital. Many social, cultural and spiritual influences played an important role in how people understood disease to be transmitted. Although infection prevention and control models based on western science continue to form the premise of reducing healthcare associated infections in Solomon Islands and locations across the globe, local social, cultural and spiritual beliefs need to be considered when planning and implementing infection prevention and control programs to ensure success.
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Affiliation(s)
- Vanessa L Sparke
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Dorothy Esau
- Baru Conservation Alliance, East Kwaio, Solomon Islands
| | - Caryn West
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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Rafiq MY, Wheatley H, Salti R, Shemdoe A, Baraka J, Mushi H. "I let others speak about condoms:" Muslim religious leaders' selective engagement with an NGO-Led family planning project in rural Tanzania. Soc Sci Med 2021; 293:114650. [PMID: 34915242 DOI: 10.1016/j.socscimed.2021.114650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022]
Abstract
In the past two decades, religious leaders have garnered increased interest from health ministries and NGOs as promoters, educators, and implementers of sensitive health programs such as family planning in several African countries. While religious leaders' role as public health actors has been well-documented, there are few ethnographic accounts of how religious leaders engage with public health programs, especially family planning. Informed by twelve months of ethnographic study in three rural and peri-urban locations in Kilombero district in 2014-2016, this article examines how Muslim religious leaders experienced and negotiated their role as implementers of family planning services. Governments and NGOs seek religious leaders' social capital to increase community's knowledge of and demand for family planning as well as to diffuse the community's moral anxieties surrounding its use. Participant observation and interviews, however, show that religious leaders selectively engage with family planning projects, balancing project demands, their own interests and the existing norms and perceptions in the community. Religious leaders stood beside other team members promoting condoms, but they remained silent themselves on condom promotion selecting instead to speak on the dangers of teenage pregnancy. Tensions, power differentials and a mélange of interests, existing and emergent, set the stage for religious leaders to selectively engage with the family planning project. Selective engagement was beneficial for both parties. Religious leaders received training on modern family planning, gained symbolic capital by associating with a powerful NGO, and expanded their social networks while government officials and NGOs received indirect support for family planning programs.
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Affiliation(s)
- Mohamed Yunus Rafiq
- Department of Social Sciences, New York University Shanghai, Pudong New Area, Shanghai, 200122, China.
| | | | - Rashid Salti
- Alliance for Women, Children and Youth Survivors, Bagamoyo, Tanzania
| | | | | | - Hildegalda Mushi
- Tanzania Commission for Science and Technology (COSTECH), Tanzania
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Persson A, Kelly-Hanku A, Mek A, Mitchell E, Nake Trumb R, Worth H, Bell S. Making Sense of Serodiscordance: Pathways and Aftermaths of HIV Testing among Couples with Mixed HIV Status in Papua New Guinea. THE ASIA PACIFIC JOURNAL OF ANTHROPOLOGY 2021. [DOI: 10.1080/14442213.2021.1942184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cheer K, Simeon L, Tommbe R, Kelly J, MacLaren D, Tsey K. Balancing it out: A grounded theory of how midwifery students at a faith-based university in Papua New Guinea provide care to women following stillbirth. Health Care Women Int 2021; 42:895-912. [PMID: 33544658 DOI: 10.1080/07399332.2020.1867860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Providing care to women following stillbirth affects the well-being of midwifery staff. In this grounded theory study, the authors used focus groups and individual interviews to explore the experiences of midwifery students at a faith-based university in Papua New Guinea. Balancing it Out is the process students used to balance social, cultural and professional factors to achieve their aim of providing the best possible care to women following stillbirth. Provision of holistic care to women following stillbirth and cross-sector health promotion are crucial to attain the best outcomes for women and the midwifery staff who provide their care.
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Affiliation(s)
- Karen Cheer
- College of Arts, Society and Education, James Cook University, Cairns, Queensland, Australia
| | - Lalen Simeon
- Deputy Vice Chancellor, Pacific Adventist University, Port Moresby, Papua New Guinea
| | - Rachael Tommbe
- School of Health Sciences, Pacific Adventist University, Port Moresby, Papua New Guinea
| | - Jenny Kelly
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.,Centre for Nursing and Midwifery Research, James Cook University, Townsville, Australia
| | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
| | - Komla Tsey
- College of Arts, Society and Education, James Cook University, Cairns, Queensland, Australia
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