Assessing the Quality of Telemedicine: A Social Interactional Investigation of Tele-Advance Care Planning Consultations in Singapore

Lim Ni Eng and KK Luke

Telemedicine, defined by the US-CDC as “the use of telecommunication and information technology to provide clinical health care from a distance,” has been available for a long time but its uptake was generally slow before Covid-19 (Almathami et al., 2020; Ekeland et al., 2010; Schumm et al., 2020; Sinha et al., 2020). According to a WHO survey, only 57% of countries had a dedicated national telehealth policy in 2016. Since the coronavirus outbreak of 2019, however, telemedicine has taken a dramatic turn towards a “springboard trajectory” (Bhaskar et al., 2020: 11). Demand and use of tele-consults have increased multiple times in many countries (Dewar et al, 2020; Grossman et al., 2020; Mann et al., 2020), and Singapore is no exception.

The aim of this research is to assess the effectiveness of telemedicine which is being adopted more and more widely within Singapore, particularly since the Covid-19 outbreak, as an alternative to traditional face-to-face consultations. We propose to do this through an empirical study of a particular kind of consultation, namely, Advance Care Planning (ACP, for End-of-Life care) sessions for the elderly, due to the multiple challenges that ACP consultations pose for videoconferencing over and above those encountered in other kinds of consultations. Through a close examination and moment-to-moment analysis of a collection of video-recordings of Tele-ACP consultations and by comparing and contrasting them with a sample of face-to-face ACP consultations, we aim to assess the effectiveness of tele-ACPs and to uncover the opportunities and challenges of telemedicine as a new and rapidly growing form of medical consultation in Singapore

Caring at a Distance: Dispassionate Bonds of Community in the Long Eighteenth Century

Peh Li Qi

My book project, Caring at a Distance: Dispassionate Bonds of Community in the Long Eighteenth Century, brings the fields of eighteenth-century science and literature and the history of emotions into conversation with one another to recover an alternative theory of care. Most cultural accounts of care tend to be grounded in forms of care that are immediately recognisable as such. Revolving around analyses of fictional and real-life caretakers who work with young, sick, or disabled individuals, such accounts delineate the complex dynamics that exist between carers and those they care for and how these dynamics in turn affect understandings of society, politics, and government. Such a mode of analysis tends, understandably, to assume that care involves social interaction and emotional exchange. But this is not always the case, and it is not necessarily true that those who render care mechanically are being inauthentic or cruel. Caring at a Distance proposes that contrary to what economist and moral philosopher Adam Smith posits, one can care for others while remaining emotionally distant. We can discern and respond to the needs of those around us, that is, without feeling called to do so. In reimagining the forms that care can take, this project hopes to advance new solutions to caretaker burnout and propose ways of rendering care on a wider and more sustainable scale. 

Funded by the Research Rehabilitation Institute of Singapore (RRIS), The Healthcare Worker’s Journey of Stroke Care and Recovery is now completed (2019-2022). 6 key challenges were identified from our transcripts and a Care Continuity Advocate Model (CCAM) was constructed. The next project is The Stroke Survivor’s Journey of Stroke Care and Recovery. The project will interview 50 stroke survivors and their family caregivers, as well as close read Singapore stroke narratives to identify key challenges they faced and construct a model of quality stroke care that will be compared with CCAM to gain a holistic perspective of what quality stroke care in Singapore should look like beyond official guidelines and textbook definitions.   

chiangmichelle.com/research

Healing Plants and Their Cultural Meaning: An Intangible Heritage between Linguistics and History of Medicine

Interdisciplinary Story as End-of-Life Healing: Palliative Care Film/Literature

Ian Dixon

Singapore faces a problem: by 2040 our aging population will triple causing a ‘surging demand for palliative care’. Consequently, caregivers should benefit from shared support, which according to Andy Ho, relies on the arts to communicate. As a consequence, we are making a short film and book specifically about Singaporean palliative care. With scholarly input from medicine, psychology, multi-ethnic studies. literature and film, our research envisions a future of story design for practical and theoretical outcomes: film, literature and associated papers.

Significantly, the project provides the groundwork for seeking: 1) larger external grants to make a low-budget feature film on palliative care and 2) produces caregiver literature for a book-length publication. We envision the book in two parts: first, memoir/fictional stories by caregivers and patients and second; an analysis of patterns. A subsequent sociological approach asks: how can we help people in these situations more? We draw on film trained alumni to help weave the stories of needful EoL patients and families into our screenplay, works of individual literature and the eventual film narrative. Finally, a reflective process allows us to theorise new approaches to this unique and underserviced arena of life for interdisciplinary publication.

Motivations behind seeking religious and spiritual support and their impact on health and social outcomes for PLHIV in Singapore

Ritu Jain

Existing literature on religion and HIV identified that people living with HIV (PLHIV) who have a religious or spiritual affiliation believe faith helps with coping with illness and finding a renewed sense of purpose in life. Religion is also used to overcome their sense of guilt and shame in engaging in risky behaviors. However, there is no existing study on religion and HIV in Singapore, much less a study on religion as a resource for treatment or support in clinical interventions for PLHIV. 

Semi-structured qualitative interviews were conducted with a total of 73 participants. These included 56 PLHIV (30 men who have sex with men, 23 heterosexual men, 3 women) and 17 stakeholders including healthcare workers, contact tracers, religious leaders, social workers, and volunteers. Interviews focused on both PLHIV and stakeholders’ perspectives or experiences of HIV diagnosis, navigating healthcare, attitudes towards HIV, and impact of HIV on relationships. Data were analysed through inductive thematic analysis. 

Out of the 56 PLHIV participants, 40 reported having a religious or spiritual affiliation with varying degrees of practice. Participants report that their faith communities are not directly involved with HIV/AIDS treatment, support, or resource provision. Instead, participants turn to religion to cope with their illness through practice (prayer, reflection, etc) and support-seeking. Our analysis revealed that those who practice Abrahamic religions (Islam, Christianity, Catholicism) are more inclined seek support from their community members, while those of non-Abrahamic faiths (Buddhism, Taoism, Hinduism) seek spiritual support from their practice. Our analysis of both groups reveals that PLHIV are reluctant to disclose their HIV-status to members from their faiths, not because their religions, religious leaders, or fellow practitioners condemn HIV/AIDS, but because of existing prejudices against homosexuality, promiscuity, and infidelity in their religions. This indicates that cultural stigmas are being reproduced in religious groups in Singapore, as well as conflated with HIV/AIDS by our religious participants. 

This paper delineates the complex motivations of religious or spiritual practice in PLHIV. Understanding the differences between practitioners of Abrahamic and non-Abrahamic faiths is paramount to conceiving of religion or spirituality as a resource for treatment or support in clinical interventions. Further, understanding how cultural stigmas are reproduced in religious settings illuminates barriers to health and social outcomes for PLHIV, which include a reluctance to seek support from social groups due to a fear of discrimination. 

Textual Magic (forthcoming from Chicago University Press) explores the medieval belief that spoken and written words, in the form of medical charms and healing amulets, could physically change the world. The project draws on extensive manuscript research, resulting in a database of over a thousand charms copied in medieval England between the eighth and fifteenth centuries. This corpus-based approach overturns earlier assumptions about the use of charms in medieval England: for example, where previous scholars have found a hiatus in the copying of charms during the twelfth and thirteenth centuries, I have found a rich and flourishing tradition. This project highlights compelling relationships between medicine, materiality, and language to demonstrate that charm texts were seen as relics, as medical ingredients, and as divine messages. Thanks to a Tier One grant from Singapore's Ministry of Education, the texts on which this research is based will be made available as a public online database. 

The Emerging Sociology of Wastewater Surveillance 

Dhiraj Kumar Mohan Nainani

The aim of this project is to interrogate the jurimorphosis – or the constantly shifting legal materiality – of wastewater surveillance. In essence, I look at how the many non-legal actors, objects, and spaces that make up the vast infrastructural assemblage of wastewater surveillance influence (and are influenced by) the passage of law, through constant and overlapping transformations.

This is studied through three key lines of enquiry. The first involves looking at the legal history and geography of environmental surveillance in the Asian context by studying the spatio-legal regulation of disease in Singapore, and the role environmental surveillance has played in its epidemiological history. The second concerns the construction of a possible framework for a ‘more-than-human’ ethics (or rights, or even obligations) of surveillance in the post-pandemic Anthropocene. The final investigative dimension of the project involves an ethnographic study of the materiality of wastewater surveillance – from pipeline to laboratory – in order to understand what makes an assay ‘ripe for use’. 

• Michael Stanley-Baker​ (Principal Investigator)
• Faizah binte Zakaria (Co-investigator)
• Francesco Perono Cacciafoco
  

Medicines circulate across languages, regions and communities, forming cultural bridges and revealing how materials and knowledge circulate. What can the study of medicine teach us about cultural exchange, identity-formation and the transmission of knowledge?     

This project, funded by the National Heritage Board of Singapore, will build foundational digital tools to enable the cross-cultural study of the history of medicine in maritime Southeast Asia. These consist of a searchable digital text repository and digital drug term synonymy which will help identify and track medicinal products across different languages. Using these tools, we will compare the use of medical materials across three languages: Malay, Chinese and Abui. We will develop a repository of digitized and searchable Malay medical manuscripts, Chinese late imperial medical works and local Peranakan family manuscripts. We will also bring the past into dialogue with the traditions of the present, by hosting oral interviews about the use of medicinal products among Malay, Chinese and Abui speaking communities. This project will also allow scholars to publish further ethnobotanical data, and incorporate it into a comparative framework.

The digital synonymy will enable us to correlate terms across the three languages, and bring historical and contemporary texts into correlation, allowing us to study the degree to which traditional medicines – long considered to be culturally and linguistically enclosed– were built from a history of contact, borrowings and adaptation. We refer to these fluid modalities of healing as “polyglot medicine” and tentatively argue that being polyglot is a hallmark of medical traditions among the diverse communities living in maritime Southeast Asia. 

Image Credit: Lin Henghan –Huayü tonghua 华夷通, 1883

Risk compensation in monogamy and testing: illusions of safety in ABCD-premised HIV prevention communication strategies 

Ritu Jain

‘Abstinence, Being faithful, Condom usage, and Detection’ or ABCD have been considered pillars of behavioural intervention for self-protection and prevention of HIV transmission in Singapore. However, the approach has been rolled out uncritically and lacks sufficient attention to the interpretation and practice of each of these tenets among vulnerable populations. This study examines the continued relevance and impact of these principles in empowering individuals in HIV prevention. 

Semi-structured qualitative interviews were conducted with a total of 76 participants. These included 56 people living with HIV (PLHIV) of whom 30 were men who have sex with men and 26 were heterosexual men. The remaining 17 comprised healthcare professionals and allied workers. Interviews focused on participants’ knowledge of HIV, HIV prevention practices, and sexual behaviour pre-diagnosis. Using an inductive approach data were thematically analysed. 

While adherence to ABCD either collectively or in combination is the theoretical gold standard for the prevention of HIV, in practice, singular individual tenets (B, monogamy alone; or D, only frequent testing) are misinterpreted as being sufficient for HIV prevention. Specifically, interview data reveal two forms of risk compensation when adhering to certain tenets: testing as a panacea and monogamy as sufficient self-protection against HIV. Among participants, frequent testing was equated with safety and in fact, emboldened a continuation of sexual risk behaviours. While necessary for controlling transmission and accessing treatment, testing is insufficient for (self) protection from infection. Similarly, participants maintained a misconception that one’s practice of monogamy is sufficient protection from infection. Interviewees often presumed condom use was unnecessary for self-protection in stable relationships and felt no need to ascertain their partners’ HIV status. 

Both practices of monogamy and frequent testing are necessary to reduce the risk of HIV transmission. However, poor communications around prevention messaging may lead to risk compensation in the context of ABCD-premised prevention communication strategies. Policymakers and sexual healthcare providers should focus on clarifying such messaging and emphasise empowering individuals with a combination of prevention methods. This is especially important given that novel HIV prevention modalities such as pre-exposure prophylaxis have yet to scale up in many settings, including Singapore. 

Routledge Handbook of Chinese Medicine

Edited by Michael Stanley-Baker (NTU), Vivienne Lo (University College, London)

This handbook aims to showcase the latest research on medicine in China as it has developed over 3,000 years. It will identify themes concerned with both history and culture and the significance of Chinese medicine in the modern world, and invite established experts together with some of the most exciting and innovative younger researchers to respond. China will be understood as an open empire,receptive to all the in-coming influences of religion, materia medica and dietetica , and techniques that have shaped its healing traditions; and also exerting influence through the land, maritime, air and cyber networks that have connected it with other places. To avoid the pitfalls of representing Chinese medicine as a monolithic tradition, detailed attention will be paid to the social and cultural contexts within which a classical medicine emerged, as well as to the realities of everyday practice, to the extent that they can be known. The themes of the book will be traced historically through the healing traditions of Early China, medieval religious institutions, the transmission of knowledge and practice through ritual, writing and authority and the impact of the printing technologies of early modern China. The Ming period, in particular, provides a wealth of exquisitely illustrated medical works which demonstrate the eclectic healing environment. The Handbook will end with two sections on the significance of Chinese medicine in the modern world addressing issues of evidence and, most significantly, an analysis of the global impact of everyday Chinese attitudes to health. It will draw out the complex and paradoxical role of Chinese medicine in the construction of modern Chinese nation as well as its adoption as a strategy of resistance to the perception of an all powerful biomedicine in the Euro-American sphere.

Spaces of Biomedicine in East Asia

Hallam Stevens

Laboratory studies has been a critical aspect of science & technology studies and anthropology of science since the publication of Latour and Woolgar’s Laboratory Life (1979). This project is a multi-sited ethnography of labs and other biomedical spaces in Southeast and East Asia, but attempts to push laboratory studies in some new (methodological) directions.