Articles by Sjaak van der Geest
Background: The National Health Insurance Scheme (NHIS) was introduced in Ghana to ensure equity ... more Background: The National Health Insurance Scheme (NHIS) was introduced in Ghana to ensure equity in healthcare access. Presently, some low and middle income countries including Ghana are using social health insurance schemes to reduce inequity in access to healthcare. In Ghana, the NHIS was introduced to address the problem of inequity in healthcare access in a period that was characterised by user-fee regimes. The premium is heavily subsidised and exemption provided for the poorest, yet studies reveal that they are least enrolled in the scheme. We used a multi-level perspective as conceptual and methodological tool to examine why the NHIS is not reaching the poor as envisaged.
This article describes life conditions of elderly people in a rural community of Ghana. It deals ... more This article describes life conditions of elderly people in a rural community of Ghana. It deals with the paradoxical situation of elderly people who are still engaged in social activities and yet experience loneliness. It is argued that in spite of the respect given to them, elderly people are denied what they regard as the most valuable proof of respect and companionship: listening to their wisdom and advice. Their loss of that ultimate respect constitutes an experience of loneliness. The article is part of broader anthropological study on social and cultural meanings of growing old in a rural Ghanaian community.
Health-related stigma and its dramatic consequences for those stigmatized have long been a crucia... more Health-related stigma and its dramatic consequences for those stigmatized have long been a crucial concern for public health authorities globally. However, before concluding that stigma spoils the lives of people with a particular disease or disability and is a major obstacle to obtaining/providing adequate health care, it is necessary to first determine whether there is actual stigmatization related to the condition concerned. The purpose of this article is to nuance the concept of stigma through a detailed ethnographic exploration of the experiences and views of patients and others affected by the parasitic skin disease cutaneous leishmaniasis (CL) in Suriname, South America. Qualitative data on the perceptions, treatment and illness experiences of CL in Suriname was collected in 2009 and 2010 among 205 CL patients at the Dermatology Service in the capital city Paramaribo, and among 321 people in different rural hinterland villages. The exploration reveals the complex and sometimes confusing statements of patients and observers of social reactions to the disease. The authors conclude that e in contrast to other societies e CL is not generally a stigmatized disease in Suriname (though this is not to deny that stigmatization may occur occasionally). Over the past decades, the concepts of stigma and stigmatization have been abundantly theorized. But when theory drifts away from ethnographic evidence, it may turn into imprecise popular speech. In this article, we warn against inflation of the term stigma and show, through an in-depth qualitative description of reactions to symptoms of CL in Suriname, why negative reactions may not necessarily entail stigma.
Ethnography as magical realism and the discovery of the ordinary
Books and articles about David Livingstone, the 19 th century Scottish missionary, colonial pione... more Books and articles about David Livingstone, the 19 th century Scottish missionary, colonial pioneer, medical doctor, explorer, adventurer, scientist, botanist, humanist, ethnographer, and linguist, can hardly be counted. The long list of qualifications after his name partly explains the widespread interest in his life and personality. Livingstone's travels and writings were so multifaceted that discussion about them continues today. His role in Victorian England and pre-colonial Africa has been subjected to widely diverse interpretations, often instigated by ideological controversy, which are long-standing and likely to continue in the future. A website, 'Livingstone on line', included 44 biographies in only a 'selected list'!
This article raises the question of whether the practice of HIV/AIDS counselling in Ghana can be ... more This article raises the question of whether the practice of HIV/AIDS counselling in Ghana can be linked to the wisdom that older people are said to have and use when they give advice to younger family members. Older people believe they have wisdom and life experience that young people should listen to; counsellors hold an opposite view about their work, insisting that it is they who listen to people with HIV/AIDS to help them make their own decisions. In actual practice, however, HIV/AIDS counsellors predominantly give information and advice, for at least three reasons. Firstly, clients urgently need a substantial amount of medical information about the causes and prevention of HIV in order to assess their situation and make decisions. Secondly, the traditional hierarchy between nurse and patient is difficult to reverse when the two meet during counselling. Thirdly, encouraging the client not to lose hope often takes the form of a pep-talk, which leaves little room for listening by the counsellor. This paper pleads for peer counselling, as a format that combines a relative equality between counselling partners with the authoritative knowledge of the counsellor. This article is based on anthropological fieldwork among older people in a rural community and counsellors in a hospital in the Kwahu region of southern Ghana.
Sjaak van der Geest is emeritus professor of Medical Anthropology at the University of Amsterdam,... more Sjaak van der Geest is emeritus professor of Medical Anthropology at the University of Amsterdam, the Netherlands. He did fieldwork in Ghana and Cameroon and published on a wide range of topics, including perceptions and practices concerning birth control, witchcraft beliefs, Ghanaian Highlife songs, missionaries and anthropologists, anthropology of the night, and various topics in medical anthropology, in particular the cultural context of Western pharmaceuticals in non-Western communities, hospital ethnography, perceptions of sanitation and waste management, and social and cultural meanings of growing old. Personal website: www.sjaakvandergeest.nl
In a context where motherhood is an integral part of a woman's stereotype, being childless is a d... more In a context where motherhood is an integral part of a woman's stereotype, being childless is a devastating experience. We explore how these so-called deviant women manage this situation. The objective of this article is to contribute to the debate regarding infertile women's agency, resilience, and resistance. This article is based on anthropological fieldwork among urban middle-class and rural poor women. Their life histories reveal that childless women in Bangladesh, a pro-natalist, patriarchal society, are not passive victims, but rather actively fight their stigmatization and manage to survive. The childless women follow overt and covert strategies to overcome their stigmatized identity and create space for themselves in various innovative ways. The women do not resist in a coordinated way as a group, but do so individually. Given the collective nature of a society like rural Bangladesh, we believe that the women's individual acts will eventually have collective effects.
Medical anthropology is the study of medical phenomena as social and cultural phenomena. "Medical... more Medical anthropology is the study of medical phenomena as social and cultural phenomena. "Medical" is an imperious adjective that seems to suggest that medical anthropology is interested in things, thoughts, and practices related to medical science or that it is a branch of anthropology in the service of medicine. It is not; rather, for many medical anthropologists, the opposite applies. "Medical" refers broadly to anything related to health, well-being, sickness, and the treatment of ill-health.
Difficulties in identifying the poor and administrative inefficiencies account for inequity in th... more Difficulties in identifying the poor and administrative inefficiencies account for inequity in the application of exemptions in the Ghanaian National Health Insurance Scheme (NHIS).
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Articles by Sjaak van der Geest