In the Journals

Special Issue: Care in Translation: Care-ful Research in Medical Settings

March’s issue of East Asian Science, Technology and Society is a themed issue, edited by Catelijine Coopmans & Karen M. McNamara. The theme for this issue is “Care in Translation: Care-ful Research in Medical Settings”. Here are the abstracts:

Repair in Translation (open access)

Jenna Grant

In this article, the author juxtaposes writing and conversation about care for, with, and in spite of technology in Cambodia. The scene is medical care, and the actors are radiologists, engineers, cadres, and X-ray machines. A radiologist is forced to repair an X-ray machine for doctors of the revolution; the pressure and constraints are almost unreal, yet his skill in repair affirms his humanity and the specialized knowledge and creativity required for problem solving. An engineer teaches repair as he fixes an old X-ray machine. He finds words and necessary tools are missing in Phnom Penh, a familiar story of lack, yet repair is material practice that enables improvisation in spite of linguistic and epistemic challenges. A radiologist, the same one from before, in the twilight of his life, questions the dominance of technologies within medical care and the deskilling of doctors. Juxtaposing these stories bolsters attention for the mundane and creative work of keeping things going in a “broken world,” in line with the ways that care and repair are mobilized in STS. It also shows how the radical potential of “broken world thinking” is circumscribed when a broken world is the one from which people are struggling to distance themselves. What we are left with are multiple, overlapping, fraught stories of modernity in which need, choice, and pleasure of repair all have a place.

Data Reporting as Care Infrastructure: Assembling ART Registries in Japan, Taiwan, and South Korea (open access)

Chia-Ling Wu; Jung-Ok Ha; Azumi Tsuge

Collecting and reporting national data has become a routine practice for assisted reproductive technology (ART) governance. This article compares the building of national registries, the making of health statistics, and the utilization of these data in Japan, Taiwan, and South Korea. Instead of viewing data registries as tools for health surveillance or monitoring, we approach them in terms of their effectiveness in generating care. Conceptualizing ART data reporting as care infrastructure, built on Maria Puig de la Bellacasa’s “matters of care,” allows us to compare the extent to which data are collected for strengthening a community’s ethical obligation, presented as indicators that could reflect quality of care and inform evidence-based policy making that promotes clinical practices for healthy outcomes. We find that sociotechnical imaginaries for ART were shaped by the fact that, in its early stages, in vitro fertilization was considered controversial in Japan, a source of nationalist glory in Taiwan, and a marginal procedure in South Korea. This in turn led to different trajectories of designing national registries in these countries, resulting in different care outcomes. We also point to the importance of mediators, including reflexive medical practitioners, care-centered state bureaucrats, and activists, in translating registry data into better ART health care.

Rhythms of Care: Medical Travels beyond the Borders of Bangladesh (open access)

Karen M. McNamara

This article examines the experiences of Bangladeshi patients and their families as they travel transnationally within Asia for medical care. I explain how failures of biomedicine in Bangladesh feed into idealized expectations of care abroad. This medical imaginary is fueled by the hope that more expensive treatment in wealthier countries will result in better care, and it is sustained by the way the medical tourism industry operates and the way Bangladeshi patients and their families make choices and engage in the doing of care abroad. A detailed case study of a Bangladeshi cancer patient’s prolonged care in Singapore illustrates the tensions and ambivalences in the quest for the best treatment. These tensions are exacerbated by the linguistic, monetary, and emotional challenges faced in traveling back and forth between countries. While patients feel at times betrayed by experiences of care that do not meet their expectations, they also feel compelled to carry on. I capture this dynamic in the term rhythms of care, understanding these as the way the medical imaginary shapes care practices that become a scaffolding for hope to be maintained and further travel to be undertaken. I also reflect on how I become part of these rhythms by acting as the family’s interpreter as they navigate health care in Singapore.

Translating Guān’ài in the People’s War on Drugs: Enacting Relations of Care in China’s State-Run Methadone Maintenance Treatment Program (open access)

Chaoxiong Zhang; Priscilla Song

China’s state-run methadone maintenance treatment (MMT) program was launched in 2003 in response to the growing HIV/AIDS epidemic and increasing criticism of compulsory rehabilitation centers. In conjunction with providing methadone replacement therapy, the Chinese state began promoting a politicized discourse of guān’ài 关爱 (care and love) as a more effective and humane method for dealing with drug users. While the medicalization of addiction as a chronic brain disease requiring long-term pharmaceutical treatment marked a watershed moment in the debate over drug control in China, the affective recasting of addiction as a social condition worthy of care is potentially even more revolutionary. But to what extent has this project transformed Chinese drug users into a legitimate target of (state) care? Based on ethnographic fieldwork conducted in Yunnan province from 2013 to 2019, we examine how various stakeholders in China’s MMT program (including methadone recipients, clinicians, public health officials, police officers, and the general public) have attempted to translate the discourse of guān’ài into workable practices and relationships based on divergent understandings of how to care for and about Chinese drug users. Our analysis shows how attending to the everyday dynamics of guān’ài in the People’s War on Drugs provides a novel approach to theorizing the fraught politics of care.

Navigating the Body Multiple: Biomedicine, Genetics, and Sex/Gender in the Lives of CAH Patients (open access)

Mathangi Krishnamurthy

In this article, the author is interested in understanding how forms of care deployed for people with congenital adrenal hyperplasia (CAH) engage with ambiguously sexed bodies. CAH is a collection of inherited genetic conditions affecting the adrenal glands that in its classic form clinically manifests itself by way of atypical genitalia in newborn infants. It is mainly seen in females, but also in males, and often results in surgical intervention to produce a more typically sexed appearance. In this article, the author traces the ways in which genetic technologies, in cohort with clinical diagnoses and consultation sessions between geneticists, general practitioners, endocrinologists, surgeons, psychiatrists, and parents, assign sex to CAH patients and evaluate normality and abnormality vis-à-vis sexuality and gender. This project locates itself at the interstices of, on the one hand, surgical and other interventions suggested for the body to conform to genetic certainty in relation to sex, and, on the other hand, a range of cultural contexts, norms, and consequences. The author investigates how different forms of biomedicine help practitioners produce care regimes in response to the specific local, gendered, cultural, and class contexts of the CAH patient, and very specifically asks how these may or may not push the boundaries of a sex/gender binary. In the process, the author also speculates on the gendered futures available for CAH bodies.

Understanding Technology in Birth Care from the Experiences of Taiwanese Obstetricians (open access)

Chen-I Kuan

Childbirth in Taiwan is characterized by the use of intensive technological and surgical interventions. Taiwanese cesarean rates are among the highest in the world, fetal monitoring is standard, and interventions such as episiotomy and labor augmentation are routinized practices during childbirth. In this Research Note, I describe the sociopolitical context that has given rise to this situation. More specifically, based on ethnographic research concerning birth care, I explore the ways obstetricians navigate this context and highlight the values and considerations that produce and shape “care” on the ground. I argue that understanding how interventionist birth care has come about, and how it is sustained as obstetricians manage care in daily practice, is vital to inform ongoing feminist activism for women’s self-determination and the de-medicalization of childbirth in Taiwan.

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