APY2602/202/1/2020

Tutorial letter 202/1/2020

Anthropology and Health Care

APY2602

Semester 1

Department of Anthropology and Archaeology

IMPORTANT INFORMATION
This tutorial letter contains the comments on Assignment 02 and information
about the examination.

BARCODE
 CONTENTS

Page

1 INTRODUCTION .......................................................................................................................... 3
2 COMPULSORY ASSIGNMENT 01 ............................................................................................... 3
2.1 General comments........................................................................................................................ 3
2.2 Assessment .................................................................................................................................. 4
2.3 The essay question and guidelines for responding to it ................................................................. 4
3 THE EXAMINATION ..................................................................................................................... 7
3.1 Format of the examination paper .................................................................................................. 7
3.2 Examination guide ........................................................................................................................ 7
4 CONCLUDING REMARKS ........................................................................................................... 8

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Dear Student

1 INTRODUCTION
I hope you are all well and that your studies are progressing well while getting ready for your
exams. This tutorial letter contains comments on Assignment 02 and the information on the exam
format. Those of you who have submitted this assignment have received personal feedback on
your essay. If you are not pleased with your performance, study the comments in this tutorial letter
and try to see where you could have improved. As part of your learning process, work through
your comments very carefully; read them in relation to the prescribed reading in the study guide
for APY2602 and make sure that you understand why particular details have been included under
the subheadings of the assignment.
As you may all aware at this stage, the COVID-19 pandemic has led to the National State of
Disaster requiring social distancing as a means to avoid its spread. To this end, the management
of Unisa took a decision that there will be no face-to-face contact activities during the first
semester, including examinations. As such, the examination of this module, like all other semester
1 modules at Unisa, will be conducted online.

2 COMPULSORY ASSIGNMENT 01
2.1 General comments
In what follows, I provide information that could have been included in your essay. Keep in mind
that there is no model answer for this type of essay and I do not imply that the notes below
constitute all that could have been said on the topic.
Your discussion should have consisted of various parts or sections, presented under suitable
headings so that your answer was clearly structured and your arguments followed a logical
sequence. Rather than merely repeating details from the tutorial matter, your discussion should
have shown your ability to select primary facts from the tutorial material and their relevance for
the question.
Your essay should have been structured in the following way:

 The introduction
An essay must have an introduction. The introduction sets the scene for your discussion and
should state its aims and how you intend to present your answer.

 The "body" of the essay

This term is used to refer to the greater part of your essay, in other words the various sections
where you actually answer the question. Bear in mind that "body" is not a suitable heading. The
"body" incorporates the different sections which make up your discussion, each presented under
a subheading.

 The conclusion
This is the final section of your essay. Here you sum up your argument or draw the main threads
of the topic together without providing any new information.

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2.2 Assessment
Besides the structuring of your answer as described here, the following were taken into account
in our assessment of your essay:
 Technical matters:

 A heading for your answer

 Inclusion of an introduction,

 The ‘body’, which is the main part of your discussion and which is presented under
subheadings

 A brief conclusion

 A bibliography

 The use of your own words in your answer.

 The length of your answer, which should be approximately 6 pages (1200 words) in
handwriting or typed in 1½ spacing.

NOTE: If you copy your answer verbatim [reproduction of information] or word for word
from the study guide (plagiarism), you will receive NO marks for your assignment.

 Academic matters:
Your ability to present a systematic discussion on the topic under discussion

 Your understanding of the relevant issues

 Your ability to select primary rather than secondary (less important) data to include in
your answer

 Your ability to interpret the information from an anthropological perspective.

2.3 The essay question and guidelines for responding to it

THE ESSAY QUESTION

Discuss social suffering and structural violence with reference to the following:

 The Meaning of social suffering and structural violence

 Factors that contribute to social suffering

Illustrate your discussion with examples taken from the case study by Paul Farmer on social
suffering and structural violence in Haiti. [25]

NB: This introduction provides the significance of socio-cultural factors in the HIV/AIDS
epidemic and the relevance of anthropology. Remember that you can use your
introduction to highlight what your discussion is going to be about, what you aim to
achieve, as well as stating your argument. Refer to page 3 of this Tutorial Letter.

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Introduction

Suffering is universal due to our common human and biological nature. However, there exists a
type of suffering which can be prevented but which continues to plague a large part of the world’s
population. This is known as social suffering and refers to hardships caused by agencies and
powers over which a person has no control (University of South Africa 2012:49). Social suffering
is caused and perpetuated by social forces and institutions. This perpetuation is referred to as
structural violence. One of the results of structural violence can be the ‘backlisting’ of disease in
spite of advances in modern technology and general ‘progress’ of the world (Ibid).

Paul Farmer, a medical anthropologist and physician, has worked among the people of Haiti, one
of the world’s poorest countries, and has identified various social, economic and political forces
that contribute to social suffering and structural violence. Although social suffering involves large
groups or categories of people (e.g. the poor, women, children, ethnic groups etc.), the best way
to study the effects of social suffering and structural violence is through the stories of individuals.
Farmer relates the suffering of two individuals in Haiti (Acephie Josefs and Chouchou Louis) to
illustrate the influence of political and economic forces on the lives of individuals. He states that
in such case studies both the experiences of individuals and the larger social context in which
they occur are studied. In this way the social forces that are the source of the suffering are made
real terms of the experiences of individuals (Farmer 2004:286).

The meaning of social suffering

The concept of social suffering was developed by the medical anthropologists Robert Desjarlais
and Arthur Kleinman. They noted that some health problems are more readily associated with
economic and political developments than with human biology alone. Social suffering refers to
"the collective traumatic experience of people as a result of the existence of social inequality
and the unjust exercise of power" (University of South Africa 2012:54).

In Haiti, social suffering is characterised by hunger, tuberculosis, Aids, diarrheal disease,

measles, torture and rape. Farmer describes the situation in Haiti as "a sort of living laboratory
for the study of affliction" (Farmer 2004:281). A s i t i s s h o wn i n t h e c a s e s t u d y
c o n d u c t e d i n H a i t i b y F a r m e r , Acephie Josefs was one of the first people of her village
to die of Aids. She was the daughter of peasant farmers who were forced off their fertile lands
as a result of the construction of a new dam. Her family settled in Kay, a refugee town, were
it became very difficult to make a living. At the age of 19, with very little education, Acephie
was expected to assist in generating an income for her family by carrying produce to a local
market along with other women on Friday mornings. This brought the women into contact with
soldiers who would watch, hassle and flirt with them. The soldiers were among the few in an
impoverished society who earned a salary and they were often able to use this to attract the
attention of women who saw the soldier’s money as a way out of poverty. Acephie’s beauty
eventually attracted the attentions of a married but promiscuous army captain, Jacques Honorat.
Although these relations were frowned upon by older people and by Acephie's family, no one
protested because having a "moun prensipaf' or "main man" was seen as a way out of poverty.
However, Honorat fell ill, returned to the care of his wife, and died leaving Acephie empty-
handed (Farmer 2004:283).

With very few options, Acephie moved to a nearby town, Mirebalais, where she learned how to
be a house servant. At the age of 22 she found a low-paid job as a housekeeper in Port-au-
Prince. While there, Acephie fell in love with a boy, Blanco Nerette, with whom she had grown
up. Blanco was now a bus driver in Port-au-Prince. In an environment o f sixty percent
unemployment, his job commanded a great deal of respect and Acephie's attentions were easy
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to gain. Blanco and Acephie planned to marry and began pooling their money, but when
Acephie became pregnant, Blanco became nervous. Acephie was also forced to leave her
employment because a pregnant servant was considered unsightly. She returned to Kay without
Blanco who only visited once or twice. After a disagreement between Acephie and Blanco, he
disappeared and she never saw him again. Acephie gave birth to a baby daughter and soon
thereafter s h e was diagnosed with AIDS with resulted in her death.

Farmer in his case study also provides an account of Chouchou Lewis, a young man who grew
up under similar circumstances as Acephie. He became a victim of the repressive political
situation in Haiti. Haiti had been ruled by the Duvalier family, a dictatorship, for over twenty
years. They ruled by violence and imposing fear on people, mostly poor families such as
Chouchou's. A coup d'etat in 1986 was followed by a period of political instability and strife.
Chouchou was persecuted, harassed and eventually beaten to death by soldiers because of an
innocent comment he made on a truck.

The meaning of structural violence

Structural violence refers to the imposition of political and economic structures that make it
possible for more powerful people to violate the social, economic and political human rights of
less powerful people. It includes aspects such as poverty, the oppressive use of political and
military power by the state, the use of economic power to oppress poor people and
discrimination of people based on race, gender and ethnicity. Structural violence usually occurs
where social power is concentrated in the hands of a few people. These inequalities in social
power cause and maintain social suffering (University of South Africa 2012:55).

Farmer identifies racism, sexism, political violence and extreme poverty as the main forms of
structural violence that occurs in Haiti. The imposition of political, economic and social forces in
Haiti created an environment of impoverishment for many people in the country. This left them
even more powerless than they had previously been and forced them further into dire
circumstances of poverty and a search for survival, as illustrated by the experiences of Acephie
and Chouchou.

Factors that contribute to social suffering

Economic inequality and the misuse of political power are the main factors that influence social
suffering. Poverty is one of the most crippling forms of structural violence leading to social
suffering. The poor are generally less well-nourished and more prone to preventable diseases
while at the same time they have less access to health services. Political factors also play an
important role in people's lives either directly through war, violence and torture or indirectly
through various policies (University of South Africa 2012:52).

If we return to Farmer's case study and the situation in Haiti at the time, we see that the lives of
the peasants of Haiti were embedded in poverty. Initially people were able to sustain themselves
by farming, but they were rendered almost destitute by the economic a n d political decisions
of bureaucrats and the army over which they had no control. The political decision of local
bureaucrats in Port-au-Prince and the economic s u p p o r t they received from politicians in
Washington in the United States of America, led to the construction of the dam. Although it was
originally also intended to ensure regular water supplies and electricity for the economic
development of peasant farmers, neither of these services materialised as far as the peasants
were concerned, and the consequences of the construction of the dam pushed already poor
peasants into abject poverty. In this environment, people had little option but to find alternative
ways to ensure their survival and women in particular, seemed to be most vulnerable. It was
Acephie's vulnerability arising from her and her family's poverty that led to her abandoning her
schooling and to her relationship with the army captain. He infected her with HIV w h i c h

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eventually caused her death. As a married man, the captain's social status meant that he could
not provide Acephie with any security and it was his wife to whom he turned when he became
ill. So too, when she was pregnant with Blanco's child she lost her job because it was socially
unacceptable for people to have pregnant servants. Social and economic forces also helped
to shape the AIDS epidemic that led to the suffering of many people.

Like Acephie, Chouchou also grew up in an environment of poverty. He was subjected to the
same economic and political forces as Acephie, but it was eventually the political power, first the
dictatorship of the the Duvaliers, and later, following t h e coup b y th e military, o f t h e local
bureaucrats and the military that led to his brutal death. The military in fact equalled the law.
Throughout the tortuous Duvalier years and the military rule, the foreign policy of the United
States, and specifically its relevance for Haiti, was always in the background.

Conclusion

In many places in the world, illness and premature death are the leading causes of extreme
suffering. The poor people of the world are usually primary victims of structural violence. They
are most likely to be the ones to suffer and they are also more likely to have their suffering
silenced by those in power. The deaths of Acephie and Chouchou were the consequences of
direct and indirect human agency over which they had no control. The social, political and
economic forces that shaped the AIDS epidemic and ensured the collapse of community
structures led to the deaths of both young people but in different ways. From the start, both
were victims of structural violence and at the risk of dying long before they actually came into
contact with the circumstances that were directly responsible for their deaths. Acephie's and
Chouchou's stories related prime examples of the consequences of structural violence and
social suffering. Farmer uses their individual stories to illustrate ways in which people in the
same country are affected by structural violence and social suffering emerging from a wider
social context.

Bibliography

Farmer, Paul 2004. "On Suffering and Structural Violence: A View from Below" in University of
South Africa. 2012. Only Study Guide for APY2602. Pretoria: University of South Africa.

University of South Africa. 2012. Only Study Guide for APY2602. Pretoria: University of South
Africa.

3 THE EXAMINATION
3.1 Format of the examination paper
The examination question paper will be accessed through the MyUnisa portal. Your examination
will be a portfolio/essay type question. You will be given three questions of which you will be
required to choose only ONE.

3.2 Examination guide

To help you focus your preparation for the examination, it is essential that you understand the
concepts studied in the module as they form part of the answers. I advise you to study all the
themes covered in the module. Remember, this is a take home exam. You are free to consult

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your reading material, however copying verbatim will be considered as plagiarism which is a
serious academic misconduct.
For the purposes of the examination, it is important that you understand the concepts studied
throughout the module. You will be assessed with due regard to the following academic and
technical matters:

 The ability to present a systematic discussion of relevant issues

 Understanding of the subject matter
 Use of appropriate case studies or examples
 Ability to present and analyse the information from an anthropological perspective
 Originality and use of own words
Your work shall also need to comprise of the following element

 A heading OR title of their work

 Introduction
 The body of their essay
 Conclusion
 Referencing

4 CONCLUDING REMARKS
I trust that you will find these comments and guidelines useful. I wish you success with the exam.
Best wishes
Josephine Malala
(012) 429 6544
[email protected]