Introduction

The aim of this chapter is to reflect on the effects of the pandemic that have affected the social system in all its components since March 2020. The crisis has settled within a ‘permanent state of crisis’ that can be read as an inescapable condition of contemporary society. The unpredictability of certain events, with all that this entails, characterises the system of complex societies, which are in themselves inevitably risky, even when they strive to function according to apparently rational rules. The processes of globalisation stress this character and imply the acceptance of living and sharing a common human condition increasingly exposed to uncertainty and contingency. Although sociology in general (and the sociology of risk in particular) reflects on these problematic aspects, here we have chosen to refer to the analyses of two sociologists well known for their powerful humanistic perspective and biographically acquainted with crises, wars and epidemics of the past century: Edgar Morin and Franco Ferrarotti.

Their theoretical reflection is the background to two empirical researches that I conducted on the pandemic phenomenon: the first, a qualitative/visual type carried out during the first lockdown in the city of Rome, resulted in the documentary entitled ‘If not now when’, that bears witness to the dystopian aspects and social and urban exceptionalism; the second, currently in progress, is an in-depth study of the first and is the result of the national project ‘Inhabiting uncertainty’. In the latter, a research unit in Rome has been focusing on surveying the youth response to the condition of uncertainty, dedicating a special concern to the emotional, relational and imagination spheres. The voices of scholars and young people interviewed who participated in the research converge on a need that also represents a social objective: re-founding our way of being in the world and designing, through imaginative processes, different ways of inhabiting uncertainty and crisis.

Rethinking the Human Condition from the Pandemic Crisis

Pandemic, war conflict, climate emergency and economy: these are the four crises of the post-global age that accompany the great adventure of mankind and feed such a deep sense of uncertainty, both individual and social, that it now almost completely supersedes the trust hitherto placed in ‘expert systems’ (Giddens 1994).

In this chapter, I will further elaborate on my key findings in the following conceptual areas: synthesising feminist theories in higher education in Pukhtunkhwa, the inappropriateness of applying Western models to a non-Western setting, redefining cultural and religious discourses, lack of female role models in Pukhtunkhwa society, women's lack of training and experience in the decision-making process, money, marriage and masters and the appli-cation and relevance of Marxist feminism and Islamic socialism.

Synthesising Feminist Theories in Higher Education in Pukhtunkhwa

The theoretical framework of this study has been informed by work on gender inequality in education from different feminist theories (liberal, radical, Marxist and Islamic), with a common underlying theme being challenging the male-dominated nature of the field of education (Mattu and Hussain, 2004; Dean, 2007). My study adopted a radical Islamic feminist approach by challenging the cultural and patriarchal Pukhtunkhwa traditional society to empower women. As I made clear in the section addressing Marxist feminism, this study also adopted some aspects of a Marxist feminist approach, especially the recognition that women's experiences in Pukhtunkhwa (as elsewhere) are influenced by capitalism and its attendant hierarchical set of social class relations as well as by patriarchy.

I am seeking empowerment for women in Pukhtunkhwa to make decisions about their lives without confrontation with their religion and the men of their families. Instead, they should be free to achieve their goals and realise their rights in partnership with men and with an understanding of Islamic theology (Contractor, 2010) set out by contemporary writers and the concept of Ijtihad, which enables them to challenge patriarchal interpretations of their Islamic faith. In the analysis of my interview data, my sample women seemed very accepting and passive regarding their own experiences and situations. This study opens an arena for the Pukhtun women to have more confidence in making their voices heard which might contribute to transformation.

Furthermore, my study rejected the argument put forward by liberal feminists that equality should be brought about by state law. Pakistan already has a constitutional law to provide equal opportunities for men and women in edu-cation and other fields of life, but this exists only in official documents, not in practice. Similarly, the country's name is the ‘Islamic Republic of Pakistan’: it is an Islamic country, but Islam is not truly implemented in state affairs and law.

The national character of the Russians of today and their social structure, both of which are in process of evolution, are reflected almost completely in the changes which are going on in one class.

The doctor of medicine and philosophy raised a pair of strong hands which had been used in surgery at one of the war hospitals in Moscow during the afternoon, and to accompany oratory at a meeting of the Constitutional Democrats - the Cadet Party - in the evening. “You will learn at last in America that this Great War will have its benefits,” the Doctor said. “It is teaching us that we are strong; it has issued a call to us commanding us to learn to organize and act, not only in war but also in peace; it has taught us to see a world larger than the world of our family doorsteps. It has shown us that we can do all that is necessary to the old and true duties and, at our best, have energy and desire to accept new labors. The war has taught us! This morning at breakfast my children spoke of Russian victory. I said to them that the great Russian victories were in the new thought and visions of the people.”

The Doctor did not speak of any class; the words were without any suggestion of distinction between different kinds of Russian hearts and Russian heads. There are almost twice as many men, women and children in the Empire than there are in our States; the Doctor seemed to include them all. The Doctor was nearing middle age but was still pretty, even in a severe woolen suit. She is an attractive and competent woman.

The reason for her unconsciousness of sex is not difficult to define. Russia is the foremost undeveloped country in the world. It is the Potentiality of our time. Like its own flat gray expanse of physical surface beneath which untouched treasures of resource lie, a crust of mystery covers the human resource of the Russian millions; the call and the charm of Russia is not in its romantic, hazardous, youthful past, nor in its picturesque customs of the present, but in the suppressed seethe of human force beneath the crust.

Introduction

This chapter examines the health policies and physical infrastructure of healthcare delivery in Somalia. It argues that the humanitarian crisis because of the civil war in Somalia for many decades has negatively affected the formulation of policies and effective implementation of healthcare delivery in the country. In addition, the lack of a community healthcare approach has not been the center of healthcare delivery in Somalia. Thus, the nature of the healthcare needs of the citizens of the country has negatively affected the humanitarian crisis and economic development in the country. The research methods applied for this chapter involved using both questionnaire administration and semi-structured interviews to gain insights into the effectiveness of health policies as well as citizen perception of the healthcare delivery system in Somalia. Content analysis of World Health Organization, African Development Bank, and United Nations reports as well as United States Central for Disease Center (CDC) reports reviewed. Several academic journal articles were also reviewed. The finding of this research reveals that apart from the civil wars in Somalia, the healthcare delivery system in the country is severely affected by inadequate medical products, funding technology in the healthcare delivery system, inadequate health workforce, leadership, and lack of health delivery network in rural communities. In addition, poor government funding, lack of accountability or coordination in the way healthcare is delivered to citizens, and the challenges of insecurity, instability, and frequent confusion between local and international paradigms of health approaches have negatively affected the health delivery system in the country. Recommendations on how the government and private sectors could adopt a good steward leadership approach to effectively coordinate Somalia's health system's vision, direction, and policies to ensure vibrant basic healthcare services to all citizens soon are provided.

Brief History of Somalia

Democratic Republic of Somalia is a country in the northeastern Horne of the African continent. The nation has a boundary with Ethiopia in the west, and Kenya in the south. It also has a boundary with Djibouti and the Red Sea in the northwest. The Indian Ocean covers the south, east, and northeastern parts of Somalia.

Introduction

In this chapter, I aim to examine the role of emotions in the context of social movements and collective behaviours that challenge the capitalist social order. This perspective is not new, as numerous works, particularly in sociology, have contributed to a lively debate, starting with Melucci and continuing through Jasper and Goodwin (Melucci 1981; Jasper 2011; Goodwin and Jasper 2006). I would like to approach the debate from a perspective that is chiefly informed by cultural anthropology. I aim to structure my discussion on emotions within a framework that allows for the questioning of how subjectivities are shaped, alongside the theory of false consciousness. This approach enables a deeper exploration of the mechanisms through which values become dominant in the context of wider societal and cultural contradictions.

To start, it is essential to delineate the anthropological discourse on emotions, characterised by unique features that set it apart from the treatment of emotions in sociology, psychology and political science.

For a long time, anthropology paid little to no attention to the topic of emotions, which were considered the domain of psychology. This approach stemmed from a widespread assumption, outlined by Emile Durkheim's differentiation between the social (objective and influenced by external causes) and the psychic (pertaining to subjectivity, internal). Much as for other subjects such as illness and pain, the anthropological approach to emotions has historically been characterised by subordination to other disciplines. In some cases, this has allowed the idea that emotions are pre-social and pre-cultural and therefore pertain to a strictly individual sphere, the object of study for psychology or even biology. While early explorations of emotions can be identified, it was in the 1980s that the theoretical stage was established for their treatment as ‘natural’ and ‘intimate’, and as the fundamental junction between society, body and the individual (Scheper-Hughes and Lock 1987).

Anthropologists, especially within the realms of medical anthropology and ethnopsychiatry, questioned this approach following the deconstruction of the Cartesian mind-body divide. In this sense, the title of Catherin Lutz's ‘Unnatural emotions’ (1988) unequivocally signals the shift in perspective.

The war has brought to Russia one change so beneficent, so extraordinary in effect, from which the results in a short space of time have been so marked and so cumulative, that not to observe and mention it apart would be to give it less emphasis than it deserves.

Russia has tried an experiment in nationwide prohibition; the impression it has made upon her social and economic structure is deep and permanent enough to make it impossible to say that of all the lessons of the war, from whatever corner of the conflict, any has a greater significance to the future of civilization.

Upon the theory that the function of government is only to adjust the rights and obligations between man and man, and not to adjust the obligations of an individual to himself, and upon the theory that no restrictive measure is wise until a people are not only willing to legislate it but also substantially to live it, I went to Russia an opponent of any national prohibition. I promised myself to be an impartial observer, but I was filled with the expectation and perhaps the hope that I might take away support for my beliefs.

I was routed.

The facts overwhelmed me; I cannot see how a national liquor dealers’ and manufacturers’ league could go to Russia and bring back an adverse report on national prohibition. Russia has been an example of what alcohol can do to gag the voice of progress and make the colors run in the fabric of social organism - her national prohibition is an example of how the abolition of alcohol will set the tide of life running toward regeneration - over night!

In America on my return I found even sincere seekers of the truth who had succeeded in obtaining from Russia bits of evidence that the prohibition was being avoided, that the most significant effect was evasion of the law, that the law had made it impossible for those who had learned to depend upon alcohol to obtain it and hence many had died from deprivation or had tossed off cans of varnish or other stimulating poison in agony, and that the government itself was slyly breaking its own ukase.

The health of the people of Africa is essential in all ramifications to their physical and mental well-being as well as the economies of the 55 countries on the continent. Professor Robert Dibie's new Transforming Healthcare in Africa: A Comparative Analysis book will contribute another especially important framework in the human right to healthcare in the African continent. It is directed at examining how globalization, and nations interdependence affects healthcare decisions and processes across many boundaries and borders. It is especially important that students, scholars, and citizens of the world understand how these systems work or do not work. The book is also especially important because healthcare is about life and human right in Africa as well as in the world in general. While some African countries have the capacity to do so much more by understanding the variability of our worldwide health policies and practices others are not capable to do so due to ineffective political institutions, political will, lack of visionary leaders, and lack of funding. The challenge in most African countries is how to think in new ways and produce innovations that will enable them to develop organizations, processes, policies, and best practices that can be in place for a long time as well as sustain a healthy life for all citizens. The major goal of this book is to help students think more deeply about how healthcare is organized and delivered in various countries. Each country in the African continent has invented its healthcare system to respond to a particular set of forces. By examining each of the systems presented in the book, students will come away with new perspectives and ideas of what an ideal health policy should be. In addition, these innovative ideas could then be used as a series of lenses to first get new insights about each person's home country system, and what best practices to adopt. The African countries covered in this book have been successful in their respective ways. However, celebrating and valuing each of these are especially important mechanisms for advancing a better healthcare system for not only African countries but the entire world.

Introduction

This chapter examines why African leaders, senior public administrators, and rich citizens prefer to seek their healthcare in England, France, Spain, Portugal, Canada, the United States, India, Singapore, and so on. It also discusses challenges such as poor funding and infrastructure, adequate regulation and poor standards, lack of highly qualified medical staff, as well as negative perceptions that could be major reasons for a mass exodus of Africans seeking healthcare in countries outside their continent. The chapter also argues that although there are a couple of well-established private hospitals, health centers, and clinics in some African countries, there are still convoluted perceptions of poor healthcare services. The fact that patients admitted to such hospitals may not get the value for their money is also a major challenge. Therefore, to prevent gambling with their life, political leaders and rich African elites prefer to travel outside their respective nations to countries outside the continent to seek healthcare. The research conducted reveals that because of the huge gap in the healthcare sector in the African continent, many entrepreneurs from outside the continent, especially India are beginning to explore opportunities in the African continent by investing heavily in providing state-of-the-art medical facilities. Even then many rich African leaders especially those who have stolen public funds prefer to travel abroad to seek medical care. Some recommendations are provided on how African nations could start to change the poor nature of their health infrastructure, and negative perception of their healthcare delivery system.

Medical tourism is defined as a situation that galvanizes a sick person to travel to a foreign country to seek medical care, or wellness treatment (Stolley & Watson 2012). Medical tourism also occurs when consumers elect to travel across international borders to receive some form of medical treatment (Organization for Economic Cooperation and Development (OECD) Report 2007). The sick people who travel to foreign countries to seek healthcare are called medical tourists (Dalen & Alpert 2018). According to Beland and Zarzeczny (2018) and Kim and Hyun (2022), the idea of seeking treatment outside the boundaries of a person's country of residence or nation of origin has led to a new type of health industry. It has also been reported that the medical tourism industry has expanded systematically over the past two decades (Kim & Hyun 2022).

Let's Design an Institution

At this point, we have an account of good reasons. We also know that it applies to reasons for individuals and to reasons for communities. Thus, our guiding questions in taking choices often are how we see our past and who we want to be, as persons but also as a people.

What do these rather abstract conclusions entail for the design of a concrete institution? The best way to bring them to life will be to consider an example in detail. So let's design an institution together.

Suppose, political groups in a given state propose the creation of a new institution, public healthcare. To simplify, we consider a dichotomous choice. Either all pay privately for all their care or all pay collectively for everyone's care. In our private scenario, there hence are no state-funded emergency rooms, no infant vaccination campaigns, nor any of the other basic public health services that, to my knowledge, any contemporary state offers at least in larger cities. Healthcare is fully private. How could the proposed alterna-tive, fully public healthcare, further the public good? More precisely, what would be reasons to create this institution and what do these reasons imply for the institution's design?

In a political debate about the choice between all private versus all public healthcare, a proponent of universal care might see a variety of goods at stake and hence offer a variety of reasons. Table 6.1 lists some reasons and sorts them into Anscombe's three categories. These are mere examples; the list is by no means exhaustive. In the row below, you find the accusations that such a proponent might level against people who fail to see the proposed reasons as reasons. In the bottom row are the goods that, following the reasons in that column, will be realized through public care. Let's go through the details, starting with the reasons.

All three columns seem to offer plausible pro tanto reasons—whether or not you ultimately agree with any given one. Their purpose is neither to show that all states should have universal healthcare nor to evaluate particular reasons, but only to illustrate the form of correct reasoning about institutions.

Appendix 1: Maps of Pukhtunkhwa and Swat

Introduction

The World Health Organization (WHO 2020) characterizes health equity as the absence of unfair and avoidable or remediable differences in health status among groups of people. This can be achieved when those with lower socioeconomic status do not face financial barriers or other obstructions such as language, culture, stigma, distance, and an overall dearth of resources (Orach & Garimoi 2009). People living in poverty are at a greater risk of death than their wealthier counterparts, largely because they lack access to public health initiatives like clean water, sanitation, food security, education, and economic opportunities (Peters et al. 2008). Disease-specific burdens also differ by socioeconomic status as people living in poverty are more likely to die from tuberculosis than those who have higher incomes.

The purpose of this chapter is to inform the readers about the challenges facing Sierra Leone's healthcare system. The chapter examines how the nation is characterized by a severe shortage of healthcare workers and providers in clinical medicine, nursing practice, general practice, and family medicine. It argues that health equity is achieved when everyone in Sierra Leone has access to the same level of healthcare. The chapter also discusses the health trends and debates over the last decade in Sierra Leone. It covers increasing the importance of healthcare systems to meet the population's needs to achieve health equity in the country. According to the World Bank (2019), Sierra Leone has one of the world's lowest life expectancies of 54.8 years, owing to high rates of infectious diseases such as malaria, tuberculosis, and HIV/AIDS. Malaria has historically been endemic in the country, accounting for approximately 40% of hospitalizations of adults and children, while a high prevalence of late diagnosis and undiagnosed tuberculosis cases has further strained the country's healthcare sector. Furthermore, women have been exposed to more health challenges, such as their efforts as primary caregivers during the Ebola pandemic, resulting in higher infections. Maternal and child mortality remain the highest in the world. Additionally, the country's mental healthcare services and rehabilitation are also underdeveloped, owing to the pressure to develop high quality physiological healthcare facilities but also the limited concern for the mental health needs of the society issues that require professional intervention, with many former child soldiers in the civil war turning to drugs and substance abuse as coping mechanisms for their traumatic experiences.

Human beings are political animals because our personal identity and the things that make us happy exist only as part of a political community. That is at least what Aristotle thought, and this book is my attempt to revive his idea for our modern communities.

Constitutivism, the resulting theory, makes five major claims. First, that there are common goods, by which I mean an interest or an aspect of a person's well-being that only exists for several people together. A happy romantic couple, for example, has a happy relationship, and this happiness is one joint good that the spouses have together. In this, two spouses are very different from two business partners, who have synchronized but separate interests, that is, who each pursue their personal good but through a joint venture.

Second, such common goods exist only in conjunction with the personal good of each member of the group. That is, the couples’ happiness is also part of the personal happiness of each spouse and, conversely, we would not speak of a happy couple if one of them were miserable in their relation. In cases where we have common goods, we have such an existential interdependence. The personal good of each member of the group is partly constitutive of the common good they share while this shared good partly constitutes their personal good. We would, after all, also think that an unhappy relationship makes the individual spouses unhappy.

Third, the members of a political community have such a common good. This claim should not be mistaken for political romanticism. My idea is not that we all live happily and harmoniously, even though that would evidently be a desirable state of affairs. As before, my third claim is about certain things only existing in conjunction; it is a metaphysical claim about existential interdependence. Your personal happiness could not exist, that is, the things that a good life necessarily comprises could not be realized outside of a certain social structure that only states provide. To have this kind of structure is to have a state, to form a political community with the structure's other members. Conversely, the good state is one that enables a good life for its citizens, and the state's authority ultimately rests on this.

One instance is the case of Maxim. The story of Maxim will tell much of Russia at war. With its movement, its color, and its pictures it will contain much of the sum total that one can see or feel in the empire of the Czar today. In it there is the theme of the fourth of the four great dramatic facts of this conflict.

The first of these great dramatic facts, I think, is the spirit of Great Britain. No empire has ever been given the free-will service of so many men willing, if need be, to die. I spoke to a Scotland Yard secret-service man in Norway of the millions of British volunteers. “You were in England!” said he. “You saw it.” He spoke as if it were a vision.

And the second is the efficiency of Germany. I have been in five countries, and two of them are Germany's bitterest enemies. But even where anti-Prussianism is almost madness, whether among statesmen and officials, those who fight and those who wait, or those who fear and those who have suffered, there is mingled in one breath hatred and admiration.

And the third is the dignity of France. This, too, is felt everywhere. At the cold, narrow gate of Russia, on the frontier between Finland and Sweden, I met General Pau on his way to visit the Czar's army. This distinguished veteran officer of France, one-armed and not tall of stature, behind his heavy gray brows and white mustache has a countenance filled with a strange combination of power and sadness. That which is firm and resolute and that which is reflective and tender mingle in the expression of his features. I spoke of the dignity of France, and then feared I had taken too great a liberty and had changed too abruptly from some hurried words about the Russian army, whose General Staff headquarters I had just left. He smiled, however, quietly and with pleasure. “France is patient and strong,” he said. “If necessary, she will suffer without complaint, but also she will remain calm after her victories.” The Russian commandant of the frontier station looked at Pau with blinking eyes and wet his own lips with the tip of his tongue. But he said nothing.