A part of the Respect and Shame in Healthcare Bioethics Workshop Series. Speakers: Vania Smith-Oka and Sarah Howard. Register now!
“Respect and Shame in Healthcare and Bioethics” Workshop
Friday 22nd October, 13.00 UK
This workshop is part of the Respect and Shame in Healthcare Bioethics Workshop Series, and is organised at the University of Exeter by the Wellcome Trust funded Shame and Medicine Project, and Supriya Subramani, Institute of Biomedical Ethics and History of Medicine, University of Zurich.
Microaggressions as Forms of Humiliation and Shame within Medical Encounters in Mexico (Vania Smith-Oka).
How does humiliation within the obstetric encounter arise? What is the nature of this behavior, and what consequences does it have for patient wellbeing? This talk will focus on how microaggressions in the interactions between biomedical personnel and marginalized patients potentially contributes to a discriminatory local social world. Despite medical tenets and hospital guidelines delineating respect and value towards the autonomy of patients, real-life frictions between clinicians and patients as “problematic others” result in microaggressions within clinical encounters. These microaggressions result in humiliation—classifying obstetric patients based on their suitability for motherhood—and shame-moralized versions of modern motherhood inscribed on patient bodies. This work questions the efforts for universal health rights that do not address underlying social and economic inequities.
Vania Smith-Oka is a cultural and medical anthropologist who specializes on the effect of institutions (medical, economic, development) on the behavior and choices of marginalized populations, especially women. She has explored the impact of an economic development program on the reproductive lives and motherhood of indigenous women in eastern Mexico. From this research emerged her book, Shaping the Motherhood of Indigenous Mexico (Vanderbilt, 2013). She also researched the doctor-patient relationship in a maternity ward in the city of Puebla, particularly the role of space/place, notions of social and medical risk, and quality of care. Her current research is investigating how skills, practices, and attitudes of medicine are transmitted to medical students. She is specifically addressing the process by which practices such as obstetric violence become prevalent across some societies. She currently has three projects: (1) an investigation of the transmission of knowledge and attitudes to medical students in Mexico; (2) an analysis of renewed perceptions of indigeneity among college-educated indigenous youth in eastern Mexico; and (3) an investigation into the effects of obstetric violence among women living in an urban slum in Kenya.
Counting Fake Latrines: Shit, Shame and the State (Sarah Howard).
Community-led total sanitation (CLTS) aims to promote rural latrine and govern communal behaviour through invoking disgust in order to provoke shame. CLTS manuals and handbooks provide many methods through which to trigger communities into action, most of which are centred on telling people that they are eating each others’ shit (using popular or crude words equivalent to ‘shit’ in local languages is part of the technique). The disgust engendered by CLTS methods is supposed to have physical and visceral effects on individual bodies, and then to transform these reactions into the social emotion of shame. This paper will explore how a hybrid form of CLTS came to be enacted in a rural area of Amhara Region in Ethiopia. It will explore how CLTS was compatible with both neoliberal development models (in its placing of the responsibility for managing human shit with individuals rather than with states), and with Ethiopian governance practices (in its emphasis on the role of the vanguard state in directing citizens to participate). In the context of the developmental state and its longer histories, as well as religious and cultural norms and practices that privilege particular bodily modes of self-discipline, the shaming techniques prescribed by CLTS were resisted, elided and transformed in various ways. Invoking shame was ultimately only partially successful in persuading local people to build latrines.
Sarah Howard is currently an ESRC Postdoctoral Fellow in the Department of African Studies and Anthropology at the University of Birmingham. Her PhD, awarded in 2020, is an account of Ethiopia’s developmental state through the everyday lives of its lowest-level employees. Based primarily on longterm ethnographic research, the thesis explores how bodies, materials and substances are integral to the continual construction of the state.
1:00- 1:40 PM GMT: Microaggressions as Forms of Humiliation and Shame within Medical Encounters in Mexico (Vania Smith-Oka)
1:40- 2:00 PM GMT: Open discussion
Break (2:00- 2:10 PM GMT)
2:10- 3:00 PM GMT: Counting Fake Latrines: Shit, Shame and the State (Sarah Howard).
3:00- 3:20 PM GMT: Feedback from Vania Smith-Oka
3:20- 3:50 PM GMT: Open discussion
Supriya Subramani – Postdoctoral Fellow, Institute of Biomedical Ethics and History of Medicine, University of Zurich
Luna Dolezal, Associate Professor in Philosophy and Medical Humanities, University of Exeter