Challenging NHS Corporate Mentality: Hospital-Management and Bureaucracy in London's Pandemic.

Whilst NHS Health Service management is usually characterized by hierarchized bureaucracy and profit-driven competitiveness, the COVID-19 pandemic drastically disrupted these ways of working and allowed London-based non-clinical management to experience their roles otherwise. This paper is based on 35 interviews with senior non-clinical management at a London-based NHS Trust during 'Alpha phase' of Britain's pandemic response (May-August 2020), an oft-overlooked group in the literature. I will draw upon Graeber's theory of "total bureaucratization" to argue that though the increasing neo-liberalization of the health-services has hitherto contributed toward a corporate mentality, the pandemic gave managers a chance to experience more collaboration and freedom than usual, which ultimately led to more effective realization of decision-making and change. The pandemic has shown NHS managers that there are alternatives to neoliberal logics of competition and hierarchy, and that those alternatives actually result in happier and effectively, more capable staff.

'Aquí viene una Veneca más': Venezuelan migrants and 'the sexual question' in Peru.

Migrant access to sexual and reproductive health (SRH) services has been highlighted as an urgent priority for the 800,000+ Venezuelans who have arrived in Peru in recent years due to political and economic crisis. Venezuelan migrants in Peru, however, negotiate their access to SRH services in what anthropologists term a 'geography of blame', and are accused and stigmatised for having imported sexually transmitted infections to the local population. Alongside this blame, female migrants are highly sexualised and face stigma, resulting in real and perceived threats to their safety, wellbeing, and integration. By juxtaposing ethnographic research and 50 interviews conducted with female migrants living in Lima, their Limeño neighbours, and with local NGOs, the paper argues how stigma is itself a neglected public health issue. Addressing SRH needs for Venezuelan migrants is not only a question of rolling out health campaigns or providing pills, but that underlying social issues such as sexualisation and stigma need to also be recognised and incorporated into policy.

Consciously quarantined: a review of the early anthropological response to the global COVID-19 lockdown.

Whilst quarantine has been experienced in a multitude of ways around the world, for some anthropologists the quietening of public movement was met with a flurry of attentive typing. For those who were consciously quarantined, a social science response to COVID-19 was sought at University College London through a call for posts as part of the UCL Medical Anthropology blog; capturing the real-time observations and scholarly reflections on the unfolding pandemic situation as it reached its height across the globe. The global flow of coronavirus - both as a literal microbial agent and as an idea - has played out on the 'coronascape' in multiple ways since it exploded onto worldwide consciousness in early 2020. From an anthropological perspective, concerns have oscillated around a number of crucial themes, from (micro)biopolitics, governance, and sovereignty; the defence of borders from foreign bodies and post-colonial Others; a strengthening of medical pluralism and the global biomedical hegemony, and concerns over where to go from here as second-waves and the social consequences of such loom large. Such themes have often interrelated and tangoed with one another as individuals have reflected upon their significance. In this review we provide a critical overview of the first fifty-seven posts that were sent to the blog in the initial months of the pandemic; with contributors exploring the developing pandemic in over twenty countries, and with posts visited daily by over two thousand visitors from across the world during the months of the UK lockdown (March-May).

Venezuelan women's perception of sexual and reproductive health services in Lima, Peru. / Percepción de mujeres venezolanas sobre los servicios de salud sexual y reproductiva en Lima, Perú.

OBJECTIVES: To know the perception of Venezuelan women about sexual and reproductive health (SRH) services in Lima, Peru. MATERIALS AND METHODS: This study had a qualitative methodological approach; 50 migrant women in Lima and three obstetricians who provide SRH care by the United Nations Population Fund were interviewed, information was collected from July to December 2019. The SRH service in Lima was analyzed using the theory of "reproductive governance". RESULTS: Migrant women seek reproductive health and contraceptive information from pharmacists and pharmacies. There is an information deficit on free SRH care, concerns about lack of health insurance, cost barriers, and their migration status. CONCLUSIONS: "Reproductive governance" could be employed by pharmacists to support migrant women and to inform about public SRH services available in Lima.

OBJETIVOS: Conocer la percepción de mujeres venezolanas sobre los servicios de salud sexual y reproductiva (SSR) en Lima, Perú. MATERIALES Y MÉTODOS: Estudio con enfoque metodológico cualitativo; se entrevistó a 50 mujeres migrantes en Lima y tres obstetras que brindan atención en SSR por el Fondo de Población de las Naciones Unidas, la información fue recolectada de julio a diciembre de 2019. Se analizó la prestación de servicios de SSR en Lima a través de la teoría de la «gobernanza reproductiva¼. RESULTADOS: Las mujeres migrantes buscan información en salud reproductiva y anticonceptivos en farmacéuticos y farmacias. Existe un déficit de información sobre la atención gratuita de los SSR, preocupación por la falta de seguro de salud, por las barreras de costos y por su estado migratorio. CONCLUSIONES: La «gobernanza reproductiva¼ podría ser empleada por los farmacéuticos para apoyar a las mujeres migrantes y para informar sobre los servicios públicos de SSR disponibles en Lima.

Percepción de mujeres venezolanas sobre los servicios de salud sexual y reproductiva en Lima, Perú

Objetivos: Conocer la percepción de mujeres venezolanas sobre los servicios de salud sexual y reproductiva (SSR) en Lima, Perú. Materiales y métodos: Estudio con enfoque metodológico cualitativo; se entrevistó a 50 mujeres migrantes en Lima y tres obstetras que brindan atención en SSR por el Fondo de Población de las Naciones Unidas, la información fue recolectada de julio a diciembre de 2019. Se analizó la prestación de servicios de SSR en Lima a través de la teoría de la «gobernanza reproductiva». Resultados: Las mujeres migrantes buscan información en salud reproductiva y anticonceptivos en farmacéuticos y farmacias. Existe un déficit de información sobre la atención gratuita de los SSR, preocupación por la falta de seguro de salud, por las barreras de costos y por su estado migratorio. Conclusiones: La «gobernanza reproductiva» podría ser empleada por los farmacéuticos para apoyar a las mujeres migrantes y para informar sobre los servicios públicos de SSR disponibles en Lima.

Objectives: To know the perception of Venezuelan women about sexual and reproductive health (SRH) services in Lima, Peru. Materials and methods: This study had a qualitative methodological approach; 50 migrant women in Lima and three obstetricians who provide SRH care by the United Nations Population Fund were interviewed, information was collected from July to December 2019. The SRH service in Lima was analyzed using the theory of "reproductive governance". Results: Migrant women seek reproductive health and contraceptive information from pharmacists and pharmacies. There is an information deficit on free SRH care, concerns about lack of health insurance, cost barriers, and their migration status. Conclusions: "Reproductive governance" could be employed by pharmacists to support migrant women and to inform about public SRH services available in Lima.

[Qualitative analysis of the care in the family planning services offered quechua-speaking patients in Ayacucho, Peru]. / Análisis cualitativo de la atención en los servicios de planificación familiar ofrecidos a pacientes quechuahablantes en Ayacucho, Perú.

OBJECTIVES.: The aim of this study was to address and analyze the medical care provided to low-income Quechua women who use the Seguro Integral de Salud (SIS, in Spanish) (comprehensive health insurance) to access family planning services, and to determine whether there is a significant fear toward contraceptive methods because of the forced sterilizations occurred in the past. MATERIALS AND METHODS.: One hundred (100) in-depth interviews were conducted with 70 women, 10 husbands, and 20 health workers in three health centers in the province of Vilcashuaman in Ayacucho. RESULTS.: It was found that there is no significant fear of family planning due to past sterilizations, as hypothesized. No significant language barrier was found either, as most health workers spoke or were willing to learn Quechua. There were some misunderstandings and abuse between patients and health workers referred to the use of healthcare services provided by the state. A widespread fear of contraception-related cancer became evident. CONCLUSIONS: . No significant fear of past sterilizations was found; on the contrary, women are more afraid of the relationship between cancer and contraception. Health worker training should focus on understanding patient perspectives and reducing stigma around poverty, as well as explaining the reasons for being a recipient of the SIS and the "JUNTOS" program.

OBJETIVOS: . El objetivo del estudio fue abordar y analizar la atención médica brindada a mujeres quechuas de bajos ingresos que usan el Seguro Integral de Salud (SIS) para acceder a los servicios de planificación familiar, y determinar si existe un temor significante hacia los métodos anticonceptivos por las esterilizaciones forzosas ocurridas en el pasado. MATERIALES Y MÉTODOS.: Se realizaron 100 entrevistas en profundidad en 70 mujeres, 10 esposos y 20 trabajadores de salud, en tres centros de salud de la provincia de Vilcashuamán en Ayacucho. RESULTADOS: . Se encontró que no existe un temor significativo hacia la planificación familiar por las esterilizaciones ocurridas en el pasado, tal como se planteó la hipótesis. Tampoco se halló una barrera lingüística significativa, ya que la mayoría de los trabajadores de salud hablaban quechua o estaban dispuestos a aprenderlo. Hubo algunos malentendidos y malos tratos entre pacientes y trabajadores de salud, referidos al uso de los servicios asistenciales que brinda el estado. Un temor generalizado sobre el cáncer fue evidente en relación con la anticoncepción. CONCLUSIONES: . No se encontró un temor significante hacia las esterilizaciones pasadas, por el contrario, las mujeres temen más a la relación entre el cáncer y la anticoncepción. La capacitación de los trabajadores de salud debe centrarse en comprender las perspectivas de los pacientes y reducir el estigma respecto a la pobreza, además de explicar las razones para ser beneficiario del SIS y del programa JUNTOS.

Análisis cualitativo de la atención en los servicios de planificación familiar ofrecidos a pacientes quechuahablantes en Ayacucho, Perú / Qualitative analysis of the care in the family planning services offered quechua-speaking patients in Ayacucho, Peru

RESUMEN Objetivos . El objetivo del estudio fue abordar y analizar la atención médica brindada a mujeres quechuas de bajos ingresos que usan el Seguro Integral de Salud (SIS) para acceder a los servicios de planificación familiar, y determinar si existe un temor significante hacia los métodos anticonceptivos por las esterilizaciones forzosas ocurridas en el pasado. Materiales y métodos. Se realizaron 100 entrevistas en profundidad en 70 mujeres, 10 esposos y 20 trabajadores de salud, en tres centros de salud de la provincia de Vilcashuamán en Ayacucho. Resultados . Se encontró que no existe un temor significativo hacia la planificación familiar por las esterilizaciones ocurridas en el pasado, tal como se planteó la hipótesis. Tampoco se halló una barrera lingüística significativa, ya que la mayoría de los trabajadores de salud hablaban quechua o estaban dispuestos a aprenderlo. Hubo algunos malentendidos y malos tratos entre pacientes y trabajadores de salud, referidos al uso de los servicios asistenciales que brinda el estado. Un temor generalizado sobre el cáncer fue evidente en relación con la anticoncepción. Conclusiones . No se encontró un temor significante hacia las esterilizaciones pasadas, por el contrario, las mujeres temen más a la relación entre el cáncer y la anticoncepción. La capacitación de los trabajadores de salud debe centrarse en comprender las perspectivas de los pacientes y reducir el estigma respecto a la pobreza, además de explicar las razones para ser beneficiario del SIS y del programa JUNTOS.

ABSTRACT Objectives. The aim of this study was to address and analyze the medical care provided to low-income Quechua women who use the Seguro Integral de Salud (SIS, in Spanish) (comprehensive health insurance) to access family planning services, and to determine whether there is a significant fear toward contraceptive methods because of the forced sterilizations occurred in the past. Materials and Methods. One hundred (100) in-depth interviews were conducted with 70 women, 10 husbands, and 20 health workers in three health centers in the province of Vilcashuaman in Ayacucho. Results. It was found that there is no significant fear of family planning due to past sterilizations, as hypothesized. No significant language barrier was found either, as most health workers spoke or were willing to learn Quechua. There were some misunderstandings and abuse between patients and health workers referred to the use of healthcare services provided by the state. A widespread fear of contraception-related cancer became evident. Conclusions . No significant fear of past sterilizations was found; on the contrary, women are more afraid of the relationship between cancer and contraception. Health worker training should focus on understanding patient perspectives and reducing stigma around poverty, as well as explaining the reasons for being a recipient of the SIS and the "JUNTOS" program.

(Re)produciendo profesionales peruanos: la asistencia social y la ciudadanía-materna de las madres quechuas empobrecidas.

A través de los discursos de independencia financiera y «profesio-nalización¼ de la descendencia promovidos por la asistencia médica (SIS) y social (Juntos) provista por el Estado, las mujeres quechuas que viven en la pobreza descubren que, al ingresar a la maternidad, su plena ciudadanía se vuelve condicional a los comportamientos exitosos y la administración de los hijos para obtener un medio de vida más «deseable¼ que el suyo. Esto sugiere que la maternidad, mientras se es pobre, da un valor moral a las mujeres que el Estado usa para justificar su monitoreo y gobierno. Este artículo se basa en un año de trabajo de campo etnográfico en comunidades rurales y centros o puestos de salud en la provincia de Vilcashuamán, departamento de Ayacucho, Perú. Se realizaron cien entrevistas con mujeres, hombres y trabajadores de la salud, además de una importante observación participante. Si bien los discursos generalizados sobrecargan las libertades de las mujeres, existen alternativas a la «profesionalización¼ de los jóvenes indígenas que no requieren la educación financiera impuesta actual-mente a las madres. Este documento sugiere que los valores morales asignados a las maternidades pobres a veces se usan injustamente como justificación para la intervención reproductiva y la revocación de la ciudadanía plena para las mujeres indígenas pobres.

Pharmacy- and community-based screenings for diabetes and cardiovascular conditions in high-risk individuals.

OBJECTIVE: To assess a model to screen minority, elderly, and at-risk individuals for diabetes, hypertension, and dyslipidemia in pharmacy and non-health care settings. DESIGN: Multicenter, prospective, observational trial. SETTING: 26 pharmacies and 4 non-health care settings. PARTICIPANTS: 888 individuals with one or more of the following risk factors: first-degree relative with diabetes, age 55 years or older, obesity, previous diagnosis of hypertension, or a previous diagnosis of dyslipidemia. INTERVENTION: Measurement of plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and blood pressure; risk assessment using a risk factor tool; referral of participants with abnormalities to physicians. MAIN OUTCOME MEASURES: Adherence with follow-up, physician recommendations, and new diagnoses of diabetes, hypertension, and dyslipidemia. RESULTS: Pharmacists screened 888 participants in pharmacies and non-health care settings; 794 scored at least 10 on the risk factor tool and received further screenings. Of these, 81% were referred for follow-up for at least one abnormality: 15% glucose, 68% blood pressure, 66% total cholesterol, and 26% HDL-C. For those referred, the mean (+/- SD) fasting plasma glucose concentration was 179 +/- 87 mg/dL, and the random glucose concentration was 234 +/- 90 mg/dL. Of participants completing follow-up, 16% received one or more new diagnoses as follows: diabetes, 8; hypertension, 9; and dyslipidemia, 29. Therapy changed for 42% of participants. Participants who were elderly, of African American and Hispanic race/ethnicity, or those with elevated cholesterol values were at significantly greater risk for elevated glucose levels. Screenings in community pharmacy settings had improved follow-up rates with physicians compared with screenings conducted in non-health care settings. CONCLUSION: Pharmacists identified individuals with elevated glucose, cholesterol, and blood pressure values through community-based screenings. Pharmacists also identified individuals who could benefit from further control of previously diagnosed hypertension and hyperlipidemia.