Medical Anthropology Research Group

At the beginning of the 21st century, globalization transforms lives in rural and urban areas through technical innovations in communication, transport and finance, leading to unprecedented mobility and an increasing connectivity and interdependence. The impact of these changes can be felt even in remote areas and is particularly strong in cities where various human and natural forces converge. Vulnerabilities to these changes differ from one region to another and are higher in areas of rapid population growth, ecological degradation, slow economic growth and poor governance.

Africa is still the least urbanized continent but difficult living conditions in rural areas lead to unprecedented movements of people from rural to urban areas. National governments can barely meet the most urgent needs of rapidly growing populations. Vulnerabilities increase as growing proportions of the society are exposed to health risks, can barely make a living and lack access to institutions and organizations providing appropriate care and social services. Disease and poverty interlink in a vicious circle pushing increasing numbers of people across the border of social exclusion. All these changes result in a health transition of combined infectious and chronic disease.

The rate of change has clearly accelerated and the scope increased but African societies have always been exposed to change, risks and insecurity. They have developed adaptive capacities which are remarkable, facilitate transition and build resilience. Social networks and institutions play a pivotal role in storing and transferring knowledge and experience, learning to live with change and insecurity, creating diversity and flexibility in problem solving and balancing power among age and gender categories. Many people are income poor but very creative in gaining a livelihood under difficult conditions. A wealth of old and new forms of spirituality offer moral support in preventing and curing afflictions of all kind.

The Medical Anthropology research group at the Institute of Social Anthropology,  Swiss Tropical Institute and the Centre for African Studies of the University of Basel has selected three topics as priorities of exploration:

• Health, vulnerability and livelihoods
• Gender and generation
• Mobility and migration

With reference to these topics, the research group aims at developing innovative concepts, frameworks and approaches that can inform policy and practice in reducing vulnerabilities and building resilience to risks heightened by the health transition. The group emphasizes a broad focus on populations, with theoretical development in the influences that create and sustain vulnerability, build resilience and maintain livelihoods. At the centre of interest is reproductive vulnerability and resilience, especially among women, youth and the elderly, migrants and mobile populations. By reproductive vulnerability and resilience we refer to the continuum of care at key points of the life cycle from adolescence to pregnancy, birth, infancy, childhood, motherhood and old age. Evidence from ongoing and completed projects will be consolidated towards some of this conceptualization.

Members of the research group

Members’ involvement in research areas

Current Projects

Social vulnerability and resilience
Vulnerability and resilience have become buzz words for practitioners and researchers confronting rapid global change and transformations. The transversal project assesses the potential and limitation of these concepts in empirical studies focusing on and comparing across substantive areas and regional contexts: urban environmental risk in La Paz (Bolivia), rural livelihood insecurity in North Western Frontier Province (Pakistan), poverty related urban health problems in West and East Africa, and global change in a broad perspective. The urban health research concentrates on risks related to water and sanitation in Dodoma (Tanzania) and draws on additional studies on malaria in Abidjan (Côte d’Ivoire) and Dar es Salaam (Tanzania) carried out within the Work Package “Health and Sanitation” of the NCCR North-South.   
Obrist Brigit: Social Vulnerability and Resilience: Assessing the potential and limitation of a new conceptual approach for pathways to sustainable development  (2005-2009)
Granado Stefanie: “C’est le palu qui me fatigue”. Une étude en l’anthropologie de la santé sur les conceptions et les pratiques locales face au paludisme à Abidjan, Côte d’Ivoire. PhD thesis, Interfaculty Program Epidemiology, University of Basel, 2007.
Dongus Stefan: Malaria risk resulting from urban agriculture: Persisting misconception or urgent need for mitigation? Combining physical and human geographic approaches in an operational setting in Dar es Salaam (Tanzania). PhD thesis in geography, University of Freiburg i. Br. (2006-2008).

Access as a key to resilience
Although the relationship between vulnerability and access to health care services seems obvious, it has been neglected in previous research. The research group takes the lead in the development of a new conceptual framework linking health system’s perspectives on access with the Sustainable Livelihood Framework and validates this approach with empirical studies:
Kessy Flora and Brigit Obrist. The ACCESS Programme: Understanding and Improving Access to Effective Malaria Treatment in Rural Tanzania.
Dillip Angel: Gaining access to prompt and appropriate malaria treatment in the Kilombero Valley, Tanzania: A health social science perspective. PhD project, Interfaculty Program Epidemiology, University of Basel (2007-2009).
Gross Karin: Improving access of poor women: The role of institutions regarding pregnant women’s access to and use of malaria and maternal health services in the Kilombero Valley, Tanzania. PhD project, Interfaculty Program Epidemiology, University of Basel (2007-2009).
Schumacher Sylvie: Social security and health at the community level in Tanzania. MA Thesis, Centre for African Studies, University of Basel.

Women affected by HIV/AIDS
The HIV/AIDS epidemic has spurred research on vulnerability and resilience. A crucial question is what individuals and communities know and do in order to prevent, treat and live with the disease, and how the disease influences gender and generational relations. Especially since the expensive Anti-retro viral (ARV) therapies have been made available in African countries, studies in medical anthropology are needed to gain a better understanding of local understandings and practices relating to the disease, its prevention and treatment.
Schwärzler Patricia: Négociations dans un contexte en transformation: Expériences dans les relations sociales et sexuelles et VIH/sida à Ouagadougou, Burkina Faso (titre de travail). PhD project, Interfaculty Program Epidemiology, University of Basel (2002-2009).
Steuer Noemi: Resilienz im Kontext von AIDS und Stigma in Mali. PhD project in Social Anthropology, University of Basel (2005-2008).

Youth
Today’s generation of young people is the largest in history with more than half of the population worldwide being less than 25 years old. Adolescence is a very special time in life that presents both, dangers as well as opportunities. In Sub-Saharan Africa many adolescents are exposed to sexual and reproductive health risks such as HIV/AIDS and malaria. Although most of these diseases are largely preventable, especially adolescent girls are highly vulnerable due to biological as well as socio-economic and cultural reasons. Studies on adolescents mainly focus on problems instead of looking also at the capabilities and strengths of adolescents. Gender sensitive studies are needed that identify local concepts of reproductive resilience.
Pfeiffer Constanze: The role of adolescent health programmes regarding sexual and reproductive resilience in Tanzania - A rural-urban comparison. Post-doc project, Swiss Tropical Institute, University of Basel (2008-2011).

Elderly
Old-age research in developing countries is gradually gaining in importance in the Social Sciences. However, anthropological studies on elder care, care support schemes and burden of elder care are only in its initial stage. The study aims to fill this research gap. It is based upon the conceptual framework of ‘health transition’ and correlates it with the assumption of a growing ‘triangle of uncertainty’ for elderly people nowadays in developing countries. The ‘vulnerability’ concept refines the approaches by regarding elderly individuals as being social actors who share particular risks and exposures, but who can mobilise coping resources and potentials to prevent, mitigate or overcome bad outcomes.
Van Eeuwijk Piet: From ‘cure to care’ among the elderly. Old-age vulnerability in Tanzania. Funding: Swiss National Science Foundation, Project-No. 100012-117857, (2008-2010).

Migrants
While many studies have examined whether migration increases vulnerability, migrants’ access to and use of diverse resources are a research topic of growing interest. Current studies of the research group are concerned with reproductive health and transnational networks as well as positive notions of health among migrants from Sub-Saharan Africa. Studies have been carried out within research programmes of the Federal Office of Health and within projects reaching out to migrant communities.
Adam Yvonne and Magdalena Stuelb: Migrantinnen als Akteurinnen in einem lokalen Geburtssystem. Eine medizinethnologische Studie in Deutschland. PhD project, Anthropology, University of Freiburg i. Br. (2005-2008).
Büchi Silvia: Gesund sein in der Migration. Gesundheitskonzepte und Gesundheitshandeln im Alltag migrierter Afrikanerinnen und Afrikaner in der Schweiz. PhD project, Interfaculty Program Epidemiology, University of Basel (2005-2008).

Collaboration 
Ifakara Health Research and Development Centre (H. Mshinda)
Centre Suisse de Recherches Scientifiques (G. Cissé)
SANDEC (C. Zurbrügg)
“The History of Health Systems in Africa – Swiss mission hospitals and rural health delivery in the 20th century” Project, Centre for African Studies and Department of History, University of Basel (P. Harris)
ACCESS Project, Novartis Foundation for Sustainable Development (A. Schulze)
“Interdisciplinary Monitoring Project for Artemisinin-based Combination Therapy in Tanzania” (IMPACT) (P. Kachur)
Dar es Salaam City Council (D. Mtasiwa)

Funding 
Swiss National Science Foundation, Swiss Agency for Development and Cooperation, Novartis Foundation, Commission for Research Partnerships with Developing Countries, Federal Office of Public Health, private foundations and funds.

Participation in scientific associations and networks
Medical Anthropology Network der European Association for Social Anthropologists (First Chair B. Obrist, since 2006)
Arbeitsgruppe "Medical Anthropology" der Deutschen Gesellschaft für Völkerkunde (B. Obrist Vice-Chair: 2004-2005)
Schweizerische Ethnologische Gesellschaft, Scientific Committee “Medical Anthropology Switzerland” (B. Obrist, Chair since 2007)
American Anthropological Association, Society for Medical Anthropology
Arbeitsgemeinschaft Ethnomedizin, Heidelberg
Schweizerische Gesellschaft für Afrika Studien
European Association for South-East Asian Studies