[Machines and artisanal health workers]. / Máquinas y arte-sanos.

This work discusses the dominant models and tensions within the health field regarding the conceptualization of the human body (as a machine), the process of health work (industrial and artisanal models), institutions (hospitals and health centers) and primary agents (the medical corporation and the medical industrial complex). The context of analysis is the United States from the end of the 19th century to the present. Economic-political, ideological-cultural, and scientific-technical dimensions are discussed, which permeate the historicity of the field. The purpose is to illustrate how the health field has transformed over time, as well as the role instrumental reason and financial capital has played in this process, to the detriment of relational aspects.

Este trabajo discute los modelos dominantes y las tensiones, al interior del campo de la salud, entre la concepción del cuerpo humano (máquina); el proceso de trabajo médico (modelos industriales o artesanales); las institucionalidades (hospitales y centros de salud) y los principales agentes (corporación médica y complejo médico industrial). El análisis se contextualiza en EEUU desde fines del siglo XIX a la actualidad. Se discuten dimensiones económico-políticas, ideológico-culturales y científico-técnicas, que atraviesan la historicidad del campo. El propósito es elucidar cómo se viene transformando el campo de la salud, y qué peso tiene la razón instrumental y el capital financiero en ese proceso, en detrimento de lo relacional.

Máquinas y arte-sanos / Machines and artisanal health workers

RESUMEN Este trabajo discute los modelos dominantes y las tensiones, al interior del campo de la salud, entre la concepción del cuerpo humano (máquina); el proceso de trabajo médico (modelos industriales o artesanales); las institucionalidades (hospitales y centros de salud) y los principales agentes (corporación médica y complejo médico industrial). El análisis se contextualiza en EEUU desde fines del siglo XIX a la actualidad. Se discuten dimensiones económico-políticas, ideológico-culturales y científico-técnicas, que atraviesan la historicidad del campo. El propósito es elucidar cómo se viene transformando el campo de la salud, y qué peso tiene la razón instrumental y el capital financiero en ese proceso, en detrimento de lo relacional.

ABSTRACT This work discusses the dominant models and tensions within the health field regarding the conceptualization of the human body (as a machine), the process of health work (industrial and artisanal models), institutions (hospitals and health centers) and primary agents (the medical corporation and the medical industrial complex). The context of analysis is the United States from the end of the 19th century to the present. Economic-political, ideological-cultural, and scientific-technical dimensions are discussed, which permeate the historicity of the field. The purpose is to illustrate how the health field has transformed over time, as well as the role instrumental reason and financial capital has played in this process, to the detriment of relational aspects.

The Change of the Status of Joseon Medical Bureaucrats in the 15th and 16th Centuries.

In the 15th century, Joseon dynasty's goal for the stabilization of the ruling system, the ideological freedom of the era, and the necessity of medicine due to the introduction of Jin and Yuan dynasty's medicine led to the increased interest in medicine by the nobility along with tolerant practice. The practice of reading medical books is a good example of this institutional demonstration. However, by the end of the 15th century, a noticeable change had taken place. Within the nobility, there was an ideological rigidity regarding technology other than those of Confucianism, as the nobility became concentrated on the principles of Neo-Confucianism. In addition, as the publication of large-scale editions such as Uibangyuch'wi (the Classified Collection of Medical Prescriptions) came to an end, they have become less inclined to nurture talent at the level of the central government as in the previous period. In addition, as the discrimination against illegitimate children became stronger, technical bureaucrats such as medical officials, which were open to illegitimate children, came to be seen in increasingly disdainful and differentiated manners. From the late Sejong period to the early Seongjong period, the entrance of illegitimate sons into the medical bureaucracy solidified the negligence of medicine by the nobility. After then, the medical bureaucracy came to be monopolized by illegitimate sons. As for illegitimate sons, they were not allowed to enter society through Confucian practices, and as such, the only way for them to enter the government was by continuing to gain experience as technical bureaucrats. Technical posts that became dominated by illegitimate sons became an object of contempt by the nobility, and the cycle reproduced itself with the social perception that legitimate sons of the nobility could not become a medical official. Medical officials from the Yi clan of Yangseong had been legitimate sons and passers of the civil service examination in the 15th century. However, in the 16th century, only illegitimate sons became medical officials. The formation of Jungin (middleclass) in technical posts since the middle of the Joseon period is also related to this phenomenon. The Yi clan of Yangseong that produced medical officials for 130years over four generations since Yi Hyoji, a medical book reading official, is an exemplary case of the change in the social perception in the early Joseon period regarding medical bureaucrats.

Ser profesional sanitario en el siglo XXI: algunos apuntes / Ser profissional sanitário no século XXI: alguns apontes / Being a health professional in the 21st century: some notes

Desde los años 70 del pasado siglo, los teóricos de la historia han señalado el advenimiento de una nueva época, adjetivada como postmodernidad, Modernidad tardía o Modernidad reflexiva. Este nuevo tiempo, el nuestro, vendría marcado por el fin de los grandes relatos que hicieron comprensible el mundo humano occidental desde la Antigüedad, resquebrajando las viejas certidumbres y arrojando al sujeto a la atomización social y la auto-responsabilidad exacerbada de su propia existencia. Estas transformaciones ideológicas y sociales han traído profundas consecuencias en diversas esferas de la vida humana en Occidente tales como el trabajo, las relaciones personales o la política, a las que no escapa, obviamente, la medicina y la praxis médica occidental. Partiendo de este hecho, el propósito de este artículo es intentar analizar, en primer lugar, las significaciones y problemáticas de ese cambio de época. y desde ahí, y en segundo lugar, tratar de comprender las consecuencias y variaciones que esas transformaciones están suponiendo para la medicina y sus profesionales sanitarios (AU)

From 1970's theorists in History have noted the arrival of a new era known as Postmodernity, late-Modernity or reflexive Modernity. This new era, our current time, comes marked by the end of the ‘great stories’ that made western world comprehensible since ancient times, and cracking old certainties and putting the Subject in terms of social atomization and an accused self-responsibility. These ideological and social changes have brought profound consequences in many spheres (fields, scopes) in western human life, such as work, social (personal) relationships or politics, from where medicine and western practices don’t (seem to) escape. On this basis, this article tries to analyze, firstly, the meanings and difficulties of this new era; from there, and secondly, it tries to understand the consequences that these changes and variations are assuming for professionals in the fields of medicine and health (AU)

Desde os anos 70 do passado século, os teóricos da história têm assinalado a chegada de uma nova época, adjetivada como postmodernidad, Modernidad tardia ou Modernidad reflexiva. Este novo tempo, o nosso, viria marcado pelo fim dos grandes relatos que fizeram compreensível o mundo humano ocidental desde a Antiguidade, resquebrajando as velhas certezas e arrojando ao sujeito à atomización social e a auto responsabilidade exacerbada de sua própria existência. Estas transformações ideológicas e sociais têm trazido profundas consequências em diversas esferas da vida humana em Occidente tais como o trabalho, as relações pessoais ou a política, às que não escapa, obviamente, a medicina e a praxis médica ocidental. Partindo deste facto, o propósito deste artigo é tentar analisar, em primeiro lugar, as significações e problemáticas dessa mudança de época. e desde aí, e em segundo lugar, tratar de compreender as consequências e variações que essas transformações estão a supor para a medicina e seus profissionais sanitários (AU)

Significados da Hanseníase para os trabalhadores da saúde / Meanings of Hansen's disease for health workers

No decorrer da história humana, a hanseníase esteve atrelada ao imaginário social da lepra e do leproso, produzindo significados e sentidos relacionados ao isolamento dos acometidos, a caridade, ao estigma e preconceito. O que está em produção social e que regem as práticas profissionais não estão descritos apenas nos manuais e nas rotinas dos serviços de saúde, mas também são guiados pelos significados e sentidos do processo saúde-doença-cuidado. Para Vigotski significados e sentidos são construídos socialmente nas relações socioculturais, a partir da interação com o outro. Diante disso, buscamos responder a seguinte pergunta: Quais são os significados e sentidos da hanseníase para os trabalhadores da saúde de serviços ambulatoriais, de uma cidade no interior paulista, voltados ao tratamento de hanseníase? Nesse contexto, o objetivo deste estudo foi de analisar os significados da hanseníase para os trabalhadores da saúde. Utilizou-se a abordagem histórico-cultural, por meio da proposta da identificação dos Núcleos de Significação provenientes da análise das entrevistas com os trabalhadores. Ao todo, o estudo, contou com a participação de treze trabalhadores de diferentes disciplinas (enfermagem, medicina, serviço social e fisioterapia). Os resultados foram discutidos dentro de quatro capítulos. No capítulo 1 foi abordado os aspectos relacionados a vivência pessoal dos participantes (infância, formação, trabalho, família) em relação a hanseníase. Alguns trabalhadores contaram que tiveram algum familiar ou conhecido próximo com hanseníase e, relatam como essa experiência influenciou nas formas de significar a doença. Muitos relataram que tiveram uma formação deficiente ou até mesmo nula em relação a hanseníase. No segundo capítulo, identificou-se aspectos relacionados ao estigma e ao preconceito ainda presente na sociedade, mesmo após a descoberta da poliquimioterapia. Aspectos estes enraizados culturalmente e que vem sendo traduzidos nas ações das políticas públicas e do trabalho em saúde. O terceiro capítulo relaciona-se as dicotomias, desafios e potencialidades no cotidiano dos trabalhadores da saúde, o qual identificou o olhar e a postura dos profissionais atrelados ao sentimento de "dó", caridade, contrariando os princípios da política nacional de humanização. O último capítulo foi escrito buscando articular questões entre a hanseníase e a tuberculose, no contexto francês e brasileiro a partir da experiência da pesquisadora. Em suma, os significados e sentidos são produtos históricos e sociais e são construídos desde a infância, perpassam a vida profissional e continuam se modificando no decorrer do dia a dia do trabalho

Throughout human history, Hansen's disease has been linked to the social imagery of leprosy and lepers, producing meanings and senses related to the isolation of those affected and to charity, stigma and prejudice. What is in social production and that govern professional practices are not only described in the manuals and routines of health services, but are also guided by the meanings and senses of the health-disease-care process. For Vygotsky meanings and senses are socially constructed in sociocultural relations, from the interaction with another. In view of this, we sought to answer the following question: What are the meanings and senses of Hansen's disease from the point of view of outpatient services health workers from a city in São Paulo state focused on this disease treatment? In this context, this study aimed to analyze the meanings of Hansen's disease for health workers. The historical-cultural approach was adopted, by means of the proposal of the meaning core identification from the analysis of the interviews with the health workers. In total, thirteen workers attended the study from different disciplines (nursing, medicine, social work and physiotherapy). The results were discussed within four chapters. In chapter 1, the aspects related to the personal experience of the participants (childhood, training, work, family) in relation to Hansen's disease were presented. Some workers reported having had a close family member or acquaintance with this disease, and described how that experience influenced the ways of meaning it. Many have reported that they have had a poor or even null training in Hansen's disease. In the second chapter, aspects related to the stigma and prejudice still present in society, even after the discovery of multidrug therapy, were pointed out. These aspects are culturally rooted and have been translated into public policies and health work. The third chapter concerns the dichotomies, challenges and potentialities in the daily routine of health workers, which identified the look and posture of professionals linked to the feeling of "pitty" and charity, contradicting the principles of the National Humanization Policy. The last chapter was written seeking to articulate questions between Hansen's disease and tuberculosis, in the French and Brazilian contexts, based on the researcher's experience. In sum, meanings and senses are historical and social products that are built from childhood passing through professional life and continue to change in the course of daily work

"It may not cure you, it may not save your life, but it will help you".

In the modern world, we are experiencing an epidemiological shift represented by the increasing prevalence of chronic diseases relative to that of acute diseases: more people are living longer, with more diseases, than ever before in human history. How are we to understand and to respond to this change? A study of provision of cancer treatment in Western Australia, especially among Indigenous populations, can illuminate ways in which healthcare providers and societies might better understand the treatment of chronic disease: healthcare providers should take care to appreciate patient perspectives and beliefs about disease aetiology and treatment. Consideration of treatment of disease in the ancient Graeco-Roman world supports the view that effective healing and maintenance of patient wellbeing occurs when healers communicate clearly with their patients about disease and treatment progression, and when healers are open-minded about patients' utilisation of multiple treatment modalities.

Proposing a practical clinical model.

Patients experience benefits from stroke rehabilitation while simultaneously confronting frustrating limitations in recovery. Some of these limitations occur beyond the visibility and recognition of physicians and other health care professionals. Kaufman's phenomenological study of boundaries of authority and responsibility in medicine thoughtfully examines factors contributing to these limitations following stroke. One source of boundaries affecting these experiences are the conceptual models guiding the provided care. One is the well-established biomedical model. Biologically nonmeasurable aspects of a patient are left unconsidered. A more holistic model risks condoning medical interventions in nonbiological dimensions of a person's life. Kaufman suggests that conflict between these perspectives can contribute to suffering in the cases examined. This stimulates reflection on what might be done differently. Although not eliminating boundaries between health care and individual's experiences of chronic illness and health conditions, a practical clinical framework, the Siebens Domain Management Model (SDMM), can bridge some of these boundaries. It integrates the biomedical and the holistic biopsychosocial models. The framework is understandable to patients, bridging the gap between the health care providers' and individuals' life worlds. With consistent application over time, the SDMM framework may lessen some care limitations and associated suffering resulting from boundaries described by Kaufman.

A view from the streets: women and medical work in Elizabethan London.

In Elizabethan London, women occupied a significant position in the city's medical marketplace, both as consumers of medical services and as practitioners. Though male medical authors of the period objected to the presence and practices of these women, a very different view of their medical work emerges if we shift our historical vantage point to the streets, houses, churches, and hospitals of the city. Using relatively underutilized sources such as parish records, probate records, lists of immigrants to London, hospital records, and individual manuscripts it is possible to draw a richer, more detailed portrait of how female health-care workers engaged with the business of health and healing. Women emerge from these records as active, prominent, and acknowledged participants in the delivery of services that promoted and preserved the health of many Londoners from cradle to grave. Hired by public institutions such as parishes and hospitals, as well as by private individuals, women were central figures in the delivery of nursing, medical, pharmaceutical, and surgical services throughout the city as part of organized systems of health care. Exploring how Londoners saw female practitioners, and how women played a recognized role within the city's range of health-care options, demonstrates that women were crucial to community health, and were also valued as such by their neighbors and patients.

[Legal regulation of participation of medical personnel in the international peacemaking action: genesis and trends of the development].

The article is devoted to the question on legal regulation of participation of medical personnel in an international peacemaking action.

[Not Available]. / [Epigraphic data from ancient times concerning physicians who lived in the modern Bulgarian regions]

The author selected and translated from Bulgarian publications 11 inscriptions from tombstones (epitaphs), votive and memorial stones. The inscriptions referred to are usually in Greek, and more rarely in Latin, and date back to the I-VI century of the modern era. Of particular significance are the inscriptions from the Aesclepiades from Odessos (the modern city of Varna), about Glaucos, the athenian from Mesambria (Nessebar) and about Spartakos Deixipos from Tzimidrene (Batkun), who is the only Thracian physician epigraphically certified. The medical association is also mentioned, as well as a Roman military physician, a veterinary physician etc.