A few minutes with Anette Wickström...

…a researcher whose social anthropological research compares healthcare work in Sweden and South Africa.

Your PhD from 2008 focussed on how Zulu families in South Africa view healthcare, medicine and illness, and the clashes that sometimes occur in healthcare. Now you’ve got funding from the Swedish Research Council to investigate what happens when Swedish young people are subject to various types of health-care related interventions. Are there links between the two research projects?

”Yes, absolutely. My thesis on South Africa was partly about better understanding poor people in rural KwaZulu Natal – what they do to stay healthy, how they make sense of and understand their experience of illness and the treatment of illness. Many domestic and western prevention projects are perceived as foreign by the local residents and there is a risk that the interventions are misdirected. In my current research, as part of a team at the Department of Child Studies, I study what happens when interventions aimed at Swedish children are implemented. I look firstly at how girls perceive and relate to manual-based programmes on depression prevention, and secondly at how young people relate to the orthodontics they are offered.”

What results did the studies show?

”For six months I followed seven 13-year-old girls who took a manual-based programme in school to improve their well-being. These programmes are sold to Swedish schools and are frequently used in values education and student health. Many programmes have their origins in medicine, and they clash with the school situation and the aim of the teacher to adapt instruction to each specific situation. No one has studied what actually happens when these are implemented. The programme I followed is based on medical definitions of symptoms of mental illness, but was used as a preventive programme for healthy young people. The idea is that young people need to learn cognitive techniques in order to identify negative thoughts, and try to change them. But the girls firmly refused to discuss their thoughts. They sat there in silence, rocking back and forth on their chairs, arranging their binders during numerous long exercises. But when they came to a few more marginal exercises, where they could do things together, they wanted to spend more time on these. Together with the teacher they adjusted the programme so they could focus on relationships, their own interests and skills, instead of identifying negative thoughts. Based on the study, I present a critical discussion on the usefulness of manual-based courses in school.”

”When it comes to orthodontics I had 83 consultations and then followed eight adolescents who proceeded with examinations. Very often the changes are aesthetic. I studied the interaction between the young people and the dentist: how they talk about appearances and normality, and I try to understand the young people’s thinking on this topic. How do they view the offer of orthodontics and the normalisation idea that accompanies this type of offer? I also study how norms are established and affected by all the technology and apparatus that is used at the clinic. It’s about interpreting what is happening, so we can understand and critically examine the interventions.

Could you give us a few more examples of what you mean?

”Of course. As I wrote in my article published in June in Medical Anthropology Quarterly, in South Africa there have been many different obstacles that prevent antiviral drugs for HIV from getting out, but we don’t know much about the obstacles that the poorest people encounter. I was surprised when a woman from Nkolokotho, where I did my field work, maintained that ”people die if they go to the hospital”. But a few years later, when my assistant suddenly died after starting to take antiviral drugs, I started to investigate this issue. According to a local doctor, estimates say that one out of ten patients who takes antiviral drugs dies, because the treatment isn’t suitable for that individual. In Europe and the United States they individualise treatment in a number of ways. However in low- and middle income countries there are only two treatments to choose from. If we don’t understand the unfair distribution of resources and people’s experiences of these sorts of events, it’s difficult to judge how they will relate to different types of interventions.”

So as a social anthropologist, you want to shed light on other perspectives of healthcare research?

”Yes. I see a huge need for social-science and ethnographic studies in healthcare research. These days, with strict requirements for efficiency, and measurements for everything, such as how young people feel, things tend to be too superficial. In an ethnographic study, the responses are interpreted more in-depth. But I want to stress that social-science and humanistic healthcare research is not only about improving interventions, but also about studying the relationship between individual, health and society. Much of the research concerns philosophical issues and its value lies in helping us understand more about people and the world we live in.