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There is a growing consensus that patient-centered care is more effective in treating patients than a strictly biomedical model, where there are known challenges to involving the patient in assessments, treatment goals, and determining preferred outcomes.
Objectives
The current study seeks to integrate patient values and perspectives by exploring how people diagnosed with a life-limiting disease define healing in their own words.
Methods
As a part of a larger study that included cognitive interviewing, we asked the question “what does the word healing mean to you?” Data were collected during face-to-face interviews with patients from three metropolitan healthcare facilities.
Results
Thirty participants responded to the question “what does healing mean to you?” Seven themes were identified through the data analysis. These themes include acceptance, feeling better, pain, social support, process, religion/spirituality, and make whole. The feeling better, pain, and process themes have subthemes.
Significance of results
Probing to understand patient perspectives and how to provide a holistic approach to care is essential to patient treatment. Patients defined healing in a broader way than how it is typically defined in literature. The patients’ definitions provide greater insight into perceptions and expectations regarding the healing process.
In the pre-Columbian Andes, the use of hallucinogens during the Formative period (900–300 BC) often supported exclusionary political strategies, whereas, during the Late Horizon (AD 1450–1532), Inca leaders emphasised corporate strategies via the mass consumption of alcohol. Using data from Quilcapampa, the authors argue that a shift occurred during the Middle Horizon (AD 600–1000), when beer made from Schinus molle was combined with the hallucinogen Anadenanthera colubrina. The resulting psychotropic experience reinforced the power of the Wari state, and represents an intermediate step between exclusionary and corporate political strategies. This Andean example adds to the global catalogue documenting the close relationship between hallucinogens and social power.
The Late Intermediate period in the south-central Andes is known for the widespread use of open sepulchres called chullpas by descent-based ayllus to claim rights to resources and express idealized notions of how society should be organized. Chullpas, however, were rarer on the coast, with the dead often buried individually in closed tombs. This article documents conditions under which these closed tombs were used at the site of Quilcapampa on the coastal plain of southern Peru, allowing an exploration into the ways that funerary traditions were employed to both reflect and generate community affiliation, ideals about sociopolitical organization, and land rights. After a long hiatus, the site was reoccupied and quickly expanded through local population aggregation and highland migrations. An ayllu organization that made ancestral claims to specific resources was poorly suited to these conditions, and the site's inhabitants instead seem to have organized themselves around the ruins of Quilcapampa's earlier occupation. In describing what happened in Quilcapampa, we highlight the need for a better understanding of the myriad ways that Andean peoples used mortuary customs to structure the lives of the living during a period of population movements and climate change.
This chapter re-evaluates the idea of the “electoral fallacy” – idea that academics and policy makers mistake elections for democracy, and in so doing exaggerate the importance of the polls. We agree that there has long been a tendency to place unrealistic expectations on the electoral process, but reject the argument that elections are unimportant when they don’t lead to political change. The great weakness of some critiques of elections that have emerged over the last twenty years – the fallacy of the fallacy – is that they have underestimated the impact of elections by misleadingly narrowing this down to the question of whether the polls result in a transfer of power. Elections have multiple, sometimes contrary effects. By creating space for politicians and voters to make reciprocal claims to patrimonial virtue they may encourage people to think of themselves primarily as members of more local communities, demanding a very personal and local accountability. But the rhetoric of campaigns and elaborate technology of elections may also encourage voters to think and behave as national citizens. In this way, electoral processes perpetuate existing forms of power at the same time as they highlight problems with, and impose constraints on, that power. Consequently, elections matter – even when they don’t change the government.
This chapter lays the foundation for what comes next by providing a summary discussion of the electoral history of each country. Intended partly to introduce names, events, dates and institutions that will be reappear in subsequent chapters, it also sets out a central element of our argument: that the history of elections has been shaped by a chronic tension between two alternative registers of virtue: a patrimonial register that revolves around reciprocity and personal relations; and a civic register that exalts bureaucratic order and emphasises the moral claims of national citizenship. The electoral histories shaped by that tension in the three countries may seem to follow different trajectories, yet they share significant features. In all three, electoral politics has continued to revolve around securing access to the resources controlled by ‘the government’; in all three, the same chronic tension persists – between elections as manifestations of civic order, and as sites for an intense local politics of clientelism and redistribution. Finally, all three continue to see high levels of electoral participation that shape political subjectivity. Widely understood as a site for moral claims-making as well as political competition, elections underwrite – albeit in a contingent way - the legitimacy of the state.
This chapter traces the history of election organization in Ghana, Kenya, and Uganda. It identifies a common pattern of technical and institutional elaboration, driven by a desire to produce procedurally perfect elections through the combination of new technologies and more professional personnel. The chapter argues that this elaboration has come at a significant financial cost, but that it has had some effect in shaping the subjectivities of those involved as electoral officials and of voters. Yet this determined attempt to promote civic virtue through electoral performance – which has attracted much support from donors - has always been challenged by forms of patrimonial claims-making that persistently intrude into the imagined order of the electoral process. Intimidation and bribery, as well as pursuit of particular interest, drive malpractice; logistical failures and errors encourage the suspicion that others may not follow the rules. Ghana, Kenya and Uganda may seem to offer different stories: Ghana’s Electoral Commission attracts international praise, while Uganda’s has been heavily criticised. Yet that difference may be overstated: there is widespread suspicion of the electoral management bodies in all three countries. The production of citizens and state through electoral performance may be powerful, but it is very far from unquestioned.
This chapter sets out the idea of the moral economy of elections in more theoretical detail, locating it in the context of a particular theoretical approach to the state that draws inspiration from the work of Timothy Mitchell and others, as well as elaborating the description of the patrimonial and civic registers. The chapter also sets out the relationship of this moral economy approach to analytical models that foregound the idea of the norm, arguing that the affective power of the behaviours and language on political subjectivity is better captured by the language of virtue and morality. The chapter concludes with a brief description of three moments that help reveal the tensions between registers of virtue that shape the moral economy of elections.
This chapter investigates civil society efforts to cultivate civic virtue through voter education programmes. We distinguish between five types of voter education: information, mobilisation, decision-making, comportment, and vigilance. Despite important differences within and between countries, we highlight how voter education efforts across all three countries seek to create "good citizens" who vote for "good leaders" by encouraging voters to internalize a civic, rather than patrimonial, register of virtue. This work has an important electoral effect and helps to imagine the Idea of civil society as a form of associational life that is of, and for, society and separate from, and capable of checking the state. At the same time, we show how, while these efforts have had some successes, they often inadvertently help to reinforce a patrimonial register – with voter education campaigns often undermined by a misunderstanding of the “problems” that need to be solved, by a failure to provide clear moral direction when other actors do not adhere to official rules, and by the complex and often contradictory roles played by civil society actors themselves. Thus, while voter education is broadly similar across all three countries, the impact is contingent on local contexts
In contrast to accounts of political mobilization that focus solely on patronage and/or co-ethnicity, this chapter argues that – to be successful – candidates need to speak to both the patrimonial and civic registers of virtue. Even aspirants who emphasise their claims to patrimonial virtue must make some claim to civic virtue and/or justify their deviation from that virtue as a necessary expedient forced on them by the nepotism or tribalism of their rivals. This need stems from the fact that both registers hold moral weight amongst the publics that politicians seek to mobilise, and is reinforced by “decampaigning” efforts whereby an aspirant’s rivals seek to attack their viability, capacity and virtue. The chapter shows how, understanding electoral campaigns in this way – i.e. as a struggle by politicians to speak to both the civic and patrimonial registers of virtue – helps to explain why campaigns are so vibrant and ground-intensive; why politicians give handouts, but also invest in projects, support particular policies, and stand up for local interests; why ethnicity can sometimes become so politically salient and divisive; and how violence and electoral malpractice can sometimes appear as justified (at least to certain audiences). Finally, the chapter underscores how politicians help to shape campaign environments through, for example, the divisions that they foster or salve, the institutions that they build or undermine, and the experiences that they imprint, but how their campaign strategies are also shaped by the political landscapes that they face – with socio-economic contexts, the structure of key political organisations, past experiences, and actions of others helping to ensure that certain messages resonate in some contexts but not in others.
This chapter discusses international observers and their efforts to improve the quality of elections. Elections are profoundly performative. They demand an audience, and since the late colonial period that audience has been in part an international one. Generations of political leaders, and civil servants, have sought to emphasise the disciplinary function of elections by reminding the public that “the eyes of the world” are upon them. The institutionalization of international election observation over the last thirty years has turned this gaze back upon the state itself: requiring and expecting behaviour in line with international norms. In the African context, though, international election observation has attracted more criticism than acclaim. We argue that this is because observers face two fundamental problems. The first is that observers’ very presence is part of the state effect of elections, conferring legitimacy, yet observers can only report critical opinions after the fact. This links to a second problem, which is that as observers respond to the numerous pressures they face they risk undermining their own credibility, especially among opposition supporters. Especially where elections have generally failed to deliver political change, this undermines the capacity of observers to encourage citizens and parties to play by the rules of the democratic game.
Introducing the idea that elections can be understood as extended moments in which multiple actors make competing claims to virtue, this chapter sets that argument in the context of an existing literature on voting and democracy in Africa. These competing claims may usefully be understood in terms of two contrasting moral registers, the civic and the patrimonial: the productive tension between these is the basis of the moral economy of elections. The making and remaking of this moral economy is shaped by four key factors: socio-economic context; the structure of political institutions; historical experience; and, the agency of actors. In the three countries studied here the moral economy constrains and enables political action in different ways. Yet in each, the moral economy shows how elections continue to attract such vigorous engagement (even where the outcome in terms of presidential power seems entirely predictable). It further explains why popular participation is not necessarily discouraged by the breaking of electoral rules; why all politicians must speak to both these moral registers; why sub-national electoral contests are often unpredictable. The moral economy approach shows why the secret ballot and adult suffrage do not always simply make national citizens, as some would hope.