Political challenges to biomedical universalism: kidney failure among Egypt's poor

Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies?

Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.

An Interpretive Approach to Religious Ambiguities around Medical Innovations: The Spanish Catholic Church on Organ Donation and Transplantation (1954-2014)

How do institutionalized religions solve moral ambiguities around controversial medical innovations and public health issues? Most religions have moral guidelines about what can and cannot be done to people's bodies, but these guidelines are not always straightforward and, when faced with certain scientific advances, can come into contradiction with other doctrinal principles. I address this theoretical puzzle through the empirical case of the Spanish Catholic Church's discourse on organ donation and transplantation during the second half of the twentieth century. Drawing on an interpretive analysis of official statements by the Spanish Catholic Church, and of the media coverage of the religious debate over organ donation and transplantation in Spain from 1954 onwards, I show that the first experiments in organ transplantation faced the Church with a contradiction between its altruistic teachings and its beliefs in the sacredness of human life. Faced with an interpretive dilemma, the Church produced a context-specific version of its official doctrine friendly to organ donation and transplantation. It did so by activating its altruistic elements and suppressing sacralized meanings of the body, thus aligning organ donation with Catholic values of generosity and fraternal love. My study theorizes this moral alignment as a semantic overlap realized through historically situated institutional discourse. Additionally, it incorporates 24 primary and secondary sources on comparative cases to propose three facilitating factors that enabled and encouraged the Spanish Catholic Church to embrace a controversial medical practice.

Comics and revolution as global public health intervention: The Case of Lissa

In this article, we discuss the inextricable entanglement of public health and political revolution, and why comics is a particularly amenable medium to explore how different people come to terms with illness and mortality against the backdrop of political, economic, and environmental crises. We discuss our process in creating a sequential comic narrative, Lissa, that portrays a working-class Egyptian family, informed by hundreds of interviews and ethnographic research in Egypt on the vulnerabilities that expose people to kidney and liver disease and the difficulties of accessing proper treatment. Lissa also draws on ethnographic research and interviews in the U.S. on a seemingly unrelated topic - the social and political calculus of managing genetic risk for breast and ovarian cancer within a commercial healthcare system. We draw out the similarities in bioethical dilemmas between these two disparate clinical realities by composing an unlikely friendship between two fictional characters: Anna, the daughter of an American oil company executive living in Cairo, who has a family history of breast cancer - and Layla, the daughter of the porter of Anna's apartment building, who grows to become a resolute physician struggling for better public health justice and rights in Egypt.

Living in a Toxic World

While the proliferation of industrial toxic substances over the past century has had drastic environmental and bodily effects, conventional methods of measuring and mitigating those effects continue to produce uncertainty. The project of living in a toxic world entails ethical, technical, and aesthetic efforts to understand toxicity as a contingent encounter among beings, systems, and things, rather than as a fundamental characteristic of particular substances. Anthropologists do not just observe such encounters; they live and work within them. This review examines recent anthropological research on toxicity, proposing that responses to toxic disaster and occupational exposure, as well as acts of familial, state, or corporate care, are all modes of “toxic worlding.” The review concludes with a summary of recent research in collaborative and engaged anthropology, suggesting that such approaches are essential not so much for purifying or detoxifying the world as for making it otherwise.

Situating biologies of traditional Chinese medicine in Central Europe

Since the concept of 'local biologies' was proposed in the 1990s, it has been used to examine biosocial processes that transform human bodies in similar and different ways around the globe. This paper explores understandings of biosocial differentiation and convergence in the case of Traditional Chinese Medicine (TCM) in the Czech Republic. Specifically, it examines how Czech TCM practitioners view TCM as universally applicable while fine-tuning it to situated biosocial conditions, experimenting with the compatibilities of various human and plant bodies as part of their generalised, clinical practice. Drawing upon ethnographic research among TCM practitioners in the Czech Republic, it suggests that in addition to the individualization of TCM therapeutics to suit particular patients, Czech TCM is characterised by collective particularization, shaped by local concerns over ethnic, environmental and cultural differences. By looking critically at TCM practitioners' sensitivities to localised biological similarities and differences it aims to contribute to understandings of the expansion of TCM in Central Europe, as well as more broadly to current social science debates over the risks and opportunities inherent in abandoning the assumption of a universal human body and biology.