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The case of the Guru Nanak Emergency Services Department: Sikh therapeutic geographies
Abstract
Why, in the early 21st century, has a publicly funded, publicly operated Canadian hospital incorporated the founding figure of the Sikh religion into its architecture and its identity? Drawing on qualitative research, this paper argues that the Guru Nanak Emergency Department is not an extension of the old tradition of naming hospitals after religious figures, but rather a novel development arising from the “super-diversity” of contemporary cities, the “spiritualizing” of healthcare ecologies, and the vigorous actions of Sikhs attempting to remedy social wounds and build ‘healthy spaces’ in the pluralistic urban environs they are part of. A new therapeutic geography is emergent; the Guru Nanak Emergency Department signals new trajectories of care propagated by the lively interrelations of spiritualized healthcare ecologies, precarious and mobile religious minorities, and the city that houses them both.
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The article assesses the complexity of religious diversity through a presentation of results from the Religion and Diversity Project, a seven-year project conducted between 2010 and 2017 and centred at the University of Ottawa, Canada. Analyzing five dimensions of diversity—the religions, lived, strength, institutional and forms dimensions—it demonstrates how results from the project support the thesis that religious diversity itself is changing in all these regards, becoming more complex, and relating in complex intersectionality with other categories of diversity such as sex and gender. The article concludes by pointing to the need to expand research into religious diversity to also include the growing nonreligious diversity in Canadian and other societies.
Canada today faces challenges that were not foreseen when the Multiculturalism policy was first adopted in 1971, and serious doubts have been raised about whether the policy can be adapted or updated to deal with these new realities. Even those who supported multiculturalism in the past have wondered whether it is time now to move to a ‘post-multicultural’ approach, and to give multiculturalism “a dignified burial.”1
This paper offers new theoretical and empirical insights into the emotional and spiritual geographies of religion in therapeutic landscapes designated for marginal and vulnerable populations. Drawing on original empirical work conducted in a Pentecostal Christian therapeutic community in the UK working in the area of addiction and rehabilitation, this paper investigates the spiritual landscapes of Pentecostal worship, and considers the emotional, spiritual and therapeutic sensibilities residents attach to, and experience during, practices of worship and prayer. By examining the complex intersections between belief, embodiment and performativity of religious practice, I illustrate how the distinct patterning of worship space can differently open out, and close down, capacities and affective atmospheres of the divine. Attention is given to the different ways in which the residents experienced this worship space, and the extent to which their presence therein created a range of therapeutic – and anti-therapeutic – experiences. Drawing on these narratives, this paper argues how the contingent configuration of care/control might be seen as both constraining and empowering for residents, underlining the importance for geographers of religion to ground conceptualisations of the staging and performance of spiritual landscapes in the divergent sensibilities and ethics of engagement individuals bring to these sites.
This article explores trauma as a form of ‘social wound’, entrenched in the intersections of local histories and social experiences of violence and displacement. Building on ethnographic accounts of displacement of Iraqis in Lebanon in the wake of the US occupation of Iraq (2003–2011), I ask: what happens when wounds travel across different social worlds and local histories of violence? The account presented tells the story of Hussein, an Iraqi refugee who escaped Iraq during the height of sectarian violence (2006–2007) and claimed asylum status as a torture victim in Lebanon. For displaced people like Hussein, the experiences of violence and uprooting were amplified by the uncertainties of everyday life in Beirut. His case shows that the selective sorting of refugees around questions of vulnerability and victimhood weaves further tensions into the social fabric of displaced peoples and their host communities. In contexts of layered histories of war, violence, displacement, and humanitarian interventions, which characterize much of the Middle East, wounds constitute the interstitial tissue of the social; they are what brings people together and what sets them apart. An ethnography of such ‘travelling wounds’ might account for the complex ways that discourses of trauma and histories of violence unravel in everyday encounters.
This paper explores the emergence of urban spaces of partnership between people of faith and those of no religious faith who come together to offer care, welfare and justice to socially excluded people. The activities of such groups are understood in terms of adjustments to the secularization thesis pointing to the possibilities of a series of emerging geographies relating to postsecular rapprochement and different forms of reterritorialization in the city. In particular, the accounts of postsecularism by Klaus Eder and Jürgen Habermas are used to explain both how the hushed-up voice of religion is being released back into the public sphere in some settings, and how the assimilation and mutually reflexive transformation of secular and theological ideas may represent crossover narratives around which postsecular partnerships can converge around particular ethical precepts and practical needs. Taking the particular example of Christian religion in western Europe, the paper traces both how a critique of secularism has led to some instances of contemporary political expression underpinned by theological precepts that are converted into practical ethics, and how a greater propensity among the Christian faith to explore faith-by-praxis has fuelled increased activity in the public sphere. Not all such activity can be regarded as postsecular, but emergent spaces of postsecular partnership in the city offer possibilities for new, perhaps liminal, geographies of resistance that cannot be explained away as simply the incorporation of religious capital into neoliberal governance. The possibilities of mutually transformative possibilities in these partnerships open both politics and faith up to processes of poststructural reterritorializing as part of the faith-in-practice of postsecularism.
Neoliberalizing Health Care, Policy Transfer and Managed CompetitionThe Rise of Managed Competition in Home Care in OntarioNeoliberal Provincial PoliticsManaged Competition and Home Care WorkersConclusion
AcknowledgmentsNotes
From an examination of recent social and cultural theory and selected work on place and space by scholars of religion I draw together resources for the development of a spatial methodology for the study of religion. In order to identify the key elements of this methodology, I discuss relations between the body and space, the dimensions, properties and aspects of space, and its dynamics, including the mutual imbrication of space, the “sacred” and sacralization. Consideration is given briefly to the application of a spatial approach, its strengths and weaknesses.
In order to understand current dynamics of religious diversity, a focus on the tangible presence of religion and the co-existence of new and longstanding religious buildings, sites and artifacts in urban spaces is a fruitful starting point. Launching the notion of iconic religion, this introduction seeks to contribute to developing a scholarly framework for the nexus of religion and the city from a spatial, material, aesthetic and semiotic angle. Situated in the interface between matter and religious meaning, religious icons are not simply carriers of meaning, but make it present.
The background to this article is the debate on cities as post-secular and super-diverse. The authors question that the concept of post-secular cities usefully sums up the complex processes currently characterizing religion in contemporary European cities. They propose that different historical memories are layered upon one another and they demonstrate how religious diversity and cities mutually shape one another. Based on empirical illustrations from research in Potsdam and Turin, the authors argue that cities affect religion by casting religious communities and their forms of sociality within particular spatial regimes and contributing to the territorialization of religious categories. Moreover, they state that religious groups shape cities by leaving durable architectural imprints on them. In particular, the article develops the notion of formations of religious super-diversity, which involves forms of religious belonging and identity that historically emerged through religious dissent and innovation, and shows that urban space is the iconic arena in which religious super-diversity becomes visible through the ways in which religious spatial strategies interact with cities’ spatial regimes. The authors identify three types of spatial strategies – place keeping, making and seeking – each of which expresses and responds to communities’ relationship to urban space in different ways. The typology is meant to serve as a tool to read complex processes taking into consideration both historical paths and contemporary religious formations.
Following on the work of Marchildon (2013) this paper examines the political challenges faced by the government of Saskatchewan in rolling out their Lean reforms to the entire provincial health system. The government’s Lean reforms were meant as a vehicle to empower patients and workers in the redesign of service delivery and the creation of a patient-centred system. Lean focuses on continuous improvement, priority setting, employee engagement and the elimination of waste. The reforms appear to have been derailed to a significant degree insofar as key actors inside the system, the media and the public have challenged the goals of the reform, the Lean methodology and process, as well as the cost of the consultants employed to oversee the process. The government’s implementation of the roll-out suffered both from the ability of key actors to withdraw their support and challenge the viability of the reforms in public as well as from a public relations perspective that put the government on the defensive about how people inside the system were being treated with the reforms. As the government moves forward it will have to adjust its implementation processes and strategy in order to overcome the now strong resistance within the health sector.Cet article fait suite à celui de Marchildon (2013) et étudie les obstacles politiques rencontrés par le gouvernement en Saskatchewan quand il a voulu étendre ses réformes « Lean » au système de santé dans son ensemble. Par ces réformes, le gouvernement voulait donner leur mot à dire aux patients et aux producteurs de soins dans la recomposition de la délivrance des soins et la création d'un système centré sur le patient. « Lean » vise l'amélioration permanente, l'établissement de priorités, l'engagement des employés et la chasse au gaspillage. Il semble que les réformes aient achoppées pour une bonne part parce que des acteurs clé à l'intérieur du système, les média et le public ont remis en cause leurs objectifs, la méthodologie et le processus de « Lean », ainsi que les coûts des consultants employés pour conduire le processus. La mise en place de la généralisation par le gouvernement a été malmenée à la fois par la capacité des acteurs clé de retirer leur soutien et de remettre en cause publiquement la faisabilité des réformes, mais aussi par une opération de relations publiques ayant contraint le gouvernement à défendre la façon dont les personnels étaient traités par les réformes. Quand le gouvernement voudra avancer sur ce dossier, il devra ajuster les processus de mise en place et sa stratégie afin de dépasser des réticences maintenant fortes au sein du secteur sanitaire.
Synopsis
In an era of unprecedented global migration and neoliberal entrenchments, the phenomenon of transnational gendered caregiving is increasingly being recognized as an outcome of today's global economic system. Concurrently, religion is re-entering what has been assumed to be a secularized public sphere. Drawing on research on the negotiation of religious and cultural plurality in healthcare, we examine how faith—sometimes as personalized expressions, other times as codified, structured and collective—shapes caregiving and illness experiences in the context of healthcare services. Demonstrating the salience of intersectional theorizing, we explore how the racialization, gendering, and classing of religion operate for diasporic women seeking and providing healthcare services in the publically-funded Canadian healthcare system that carries the marks of neoliberal ideologies, and is still largely driven by secular ideals. Rather than silencing their faith perspectives in such contexts, many express agency and civic engagement through their religiosity, mobilizing religion as social capital.
The majority of histories dealing with the Sikh people underscore a Sikh inclination for martyrdom or śahīdī, as well as a deep reverence for the Sikh martyr or śahīd. Indeed, such profound esteem is featured in the contemporary Sikh prayer, ardās. Similarly, many Sikh histories present the śahīd and śahīdī ideally, as concepts which have always been understood as they are understood today, concepts encountered and elaborated in the very hymns of Guru Nanak, the founder of the Sikh tradition. This study interrogates such conclusions by first examining the sources dealing with the putative first martyrdom in Sikhism, and then asking whether there existed within the late sixteenth- and early seventeenth-century Sikh tradition a conceptual system which could accommodate fearless resistance to despotic authority and an agonizing death. Finally, the study examines references to martyrs in eighteenth- and nineteenth-century Sikh literature. This paper locates the origins of the Sikh concept of martyrdom not in the period of the first nine Gurus (1469-1675 C. E.) but in the late seventeenth and early eighteenth century, as a consequence of the social, religious, and political environment. It is this period, moreover, that shapes the definitions of both martyr and martyrdom that we find in the early to late nineteenth century, ones far more inclusive than contemporary definitions of these terms allow.
For many years, public healthcare delivery has been in crisis mode for various reasons such as increased demand for services, demographics, waiting time concerns, rising cost of service delivery, government funding constraints, quality concerns, lack of qualified personnel, and productivity and morale issues. This situation will only get worse in the coming years. Most healthcare sectors around the globe are facing similar challenges. It is therefore only a matter of time until public healthcare sectors have to tackle these challenges with a front-line, operational approach that delivers real, short-term results to patients, clinicians, and stakeholders. This paper introduces an example of consulting based on the Lean Healthcare practiced by the Fujitsu Lean Solutions Group with Fujitsu Consulting (Canada).
This paper explores the connections between emergent postsecularity and neoliberal forms of governance. The concept of the postsecular has been increasingly debated by human geographers seeking to understand the apparent paradox that, in late secularised societies, there seems to be a renewed visibility to religion in public life. Geographical scholarship has taken issue with broad-scale suggestions of a shift from a secular to a postsecular society, arguing instead for a grounded analysis of particular spaces where the religious and the secular are co-produced and open out new lines of hybridity. Building on Cloke and Beaumont's notion of rapprochement, this paper critically examines the practical dynamics of postsecular partnerships where diverse religious, secular and humanist voices accrete around mutual ethical concerns and crossover narratives. Using the illustration of a homeless centre and drug treatment service run by the Salvation Army in the UK, I show how the translation of a theo-ethics of caritas can open up political and ethical spaces that cut against the ‘ethics’ of neoliberal governmentality. These crossover narratives are shown to result in liminal spaces that negotiate and translate religious/secular belief. The conclusion offers two further avenues for postsecular approaches studying the changing geographies of secularity, theo-ethics and neoliberalism.
In this article, we explore comparatively how migrant minorities draw from their religious resources to carve out spaces of livelihood in three global cities – Kuala Lumpur, which includes Kajang, Johannesburg and London. We also examine the spatial regimes through which the state and its apparatuses seek to manage the migrants' presence and visibility or invisibility within these urban spaces. In particular, we focus on three of the most salient dimensions of migrants' religious place making – embodied performance, the spatial management of difference and belonging, and multiple embedding across networked spaces. Although these three dimensions intersect in dynamic, often tensile ways to constitute the fabric of the life world of migrant minorities, we separate them for heuristic purposes to highlight the richness and texture of religious place making.
Sikh immigration into Canada, now over a century old, has gone through various phases and shifts as policies towards immigration by successive Canadian governments have seen various modifications. While the Sikhs today constitute a big, easily recognisable community in Canada, indispensable as a vital economic force in the country, they have also tried to construct an 'identity' of their own. The articulation of identity in the case of immigrant Sikhs, however, may not simply be understood in terms of immigrants/host society dichotomy and its dynamics; the internal dynamics of the Sikh community in Canada too need to be considered. This paper also examines the various controversies that arose from the 1970s onwards, which helped define Sikh perceptions about themselves as citizens of modern, multicultural Canada.
The health consequences of the ongoing US-led war on terror and civil armed conflicts in the Arab world are much more than the collateral damage inflicted on civilians, infrastructure, environment, and health systems. Protracted war and armed conflicts have displaced populations and led to lasting transformations in health and health care. In this report, we analyse the effects of conflicts in Iraq and Syria to show how wars and conflicts have resulted in both the militarisation and regionalisation of health care, conditions that complicate the rebuilding of previously robust national health-care systems. Moreover, we show how historical and transnational frameworks can be used to show the long-term consequences of war and conflict on health and health care. We introduce the concept of therapeutic geographies-defined as the geographic reorganisation of health care within and across borders under conditions of war.
This paper suggests that the vocabulary and meaningfulness of ‘evil’ can be re-articulated, and to some extent redeemed from the extremes of fundamentalism and relativism. It uses intellectual resources from Nigel Wright, Walter Wink and Rene Girard to reconstruct some foundations for a reworking of evil in human geography. It then presents an account of the reappearance of evil ‘after postmodernism’ in event, narrative and praxis, arguing that working through and acting against evil reveals its present nature in terms that defy the excesses of right–wing religious fundamentalism and the bland tolerance that can stem from an over-reliance on relativistic thinking. The paper considers how geographies of postsecular practice in areas such as homelessness emerge in response to discernment both of the spiritual interiorities and the exteriorities of landscapes of power, and of the ability of human action to influence these landscapes.
This paper addresses the question whether recent immigration to Canada from non-European and mostly non-Christian parts of the world is leading to increasing religious pluralism in Canada, rather than only enhanced ethno-cultural pluralism. Testing Reginald Bibby's hypothesis that, in spite of this immigration, Christianity will continue as the overwhelmingly dominant religious identification in Canada, this article analyzes data from the 1971-2001 decennial censuses. It finds that religious pluralism as measured by number and percent of adherents to major non-Christian religions is increasing and will likely continue to increase because of the composition of continuing immigration. There are, however, also countervailing trends that support continued Christian dominance as well as an increase in no religious identification. These trends include patterns in religious identification over time and the enigmatic effect of rising multiple ethnicity.
This article reviews geographical research on religion in the 1990s, and highlights work from neighbouring disciplines where relevant. Contrary to views that the field is incoherent, I suggest that much of the literature pays attention to several key themes, particu- larly, the politics and poetics of religious place, identity and community. I illustrate the key issues, arguments and conceptualizations in these areas, and suggest various ways forward. These 'new' geographies emphasize different sites of religious practice beyond the 'officially sacred'; different sensuous sacred geographies; different religions in different historical and place-specific contexts; different geographical scales of analysis; different constitutions of population and their experience of and effect on religious place, identity and community; different dialectics (sociospatial, public-private, politics-poetics); and different moralities.
This paper explores how Sikh scriptures establish a unique claim to Ayurvedic knowledge. After considering Ayurvedic creation myths in the classical Sanskrit canon, passages from Sikh liturgical texts are presented to show how Ayurveda is refashioned to meet the exigencies of Sikh theology. The Sikh texts are then analysed through their relationship with general Puranic literatures and the historical context of Hindu-Sikh relations. Finally, the Indian government's current propagation of Ayurveda is scrutinised to demonstrate its affiliation with one particular religion to the possible exclusion of others. The Sikh example provides a glimpse into local cultures of Ayurveda before the professionalisation and standardisation of Ayurvedic practice in India's post-independence period and may serve as a model for understanding other traditions.
This article analyzes the historical formation of three of the most influential Sikh militant movements operating in Canada: the World Sikh Organization (WSO), the International Sikh Youth Federation (ISYF), and the Babbar Khalsa (BK). It traces the historical formation of these three factions, paying particular attention to the mandates and ideological philosophies to which these groups subscribe, as well as their current activities. In addition, it focuses on how the infighting over the mandates of the organizations, the tensions between diaspora and homeland politics, and conflicts within groups shape the character of the organizations. Although moderate members of Canada's Sikh community have regained ownership of gurdwaras, the existence of several militant Sikh movements has raised important security questions for Canadian authorities.
How are the Internet and the World Wide Web productive of new forms of cultural life? I analyse how the confluence of martyrdom, terror, and computer-mediated-communications has contributed to the emergence of a Sikh diasporic cultural politics. I argue that the centrality and force of both the Internet and the figure of the martyr for many Khalistanis prompt a rethinking of the privilege scholars often accord to the “imagination” and “experience” in explaining the creation of diasporic communities. In outlining what I call the diasporic sublime, I mine the works of Walter Benjamin and Immanuel Kant to develop a more precise way for talking about community formation in terms of the inexperiencable and the unimaginable.
Heroism and martyrdom are central values in contemporary Sikh historiography and primary symbols in their collective memory. Both are replete with the stories of numerous heroes and martyrs who faced death, unflinchingly fighting in defense of the Sikh faith and its believers (constituting the Panth or community) against overwhelming odds. Conversely, it is considered shameful for Sikhs to become mere victims, succumbing to attacks against faith and community without fighting to the death. It is also insisted that true Sikhs do not themselves attack those who are weak or harmless; on the contrary true Sikhs come to the defense of such persons even if they are not of the same faith. However, during the last half century, Sikhs have many times become victims, as well as perpetrators of violence, being unable to act in a way consistent with their central values. The consequence has been an inability to integrate their modern history successfully into a narrative consistent with those values and to find appropriate ways of memorializing what has been done to many Sikhs and what many Sikhs have done to others.
Diversity in Britain is not what it used to be. Some thirty years of government policies, social service practices and public perceptions have been framed by a particular understanding of immigration and multicultural diversity. That is, Britain's immigrant and ethnic minority population has conventionally been characterized by large, well-organized African-Caribbean and South Asian communities of citizens originally from Commonwealth countries or formerly colonial territories. Policy frameworks and public understanding - and, indeed, many areas of social science - have not caught up with recently emergent demographic and social patterns. Britain can now be characterized by 'super-diversity,' a notion intended to underline a level and kind of complexity surpassing anything the country has previously experienced. Such a condition is distinguished by a dynamic interplay of variables among an increased number of new, small and scattered, multiple-origin, transnationally connected, socio-economically differentiated and legally stratified immigrants who have arrived over the last decade. Outlined here, new patterns of super-diversity pose significant challenges for both policy and research.
As the Indian army invaded Sikhs’ most sacred shrine, the Golden Temple, Amritsar in June 1984, the community was shattered by the resulting trauma, reacting with anger, remorse and mourning. Having woven around itself certain myths, memories and commemorations of being survivors from past genocides, the 1984 tragedy, as a contemporary reality in postcolonial India offered bitter choices. With severely restricted agencies of representation and reproduction of Sikhs’ traumatic grief and psychological pain suffered through broken ideals of a faith, undermining of historical traditions, and shattered memories – all symbolised through the destruction, construction and reconstruction of the Akal Takhat. With no prospect of an ‘honourable’ means of either forgetting or forgiving this ‘critical event’ the paper points towards the predicament of a community as it grapples to make sense of its recent past. Circumcised by the Indian state's coercion and hegemonic discourse, this paper identifies the reaction of individual Sikhs, its elite and political leaders highlighting some consequences of the tragedy, contest over interpretation, spaces for its mourning characterised by voluntary and enforced silences.
Turbans have been worn by different people around the world for at least the past 3,000 years. For one community, the Sikhs, the turban carries deep religious significance. Members of the Sikh faith - the fifth largest religion in the world - are required to wear a turban pursuant to religious mandate.In the aftermath of the terrorist attacks of September 11, 2001, Sikh turbans have taken on a new meaning. Because Non-Sikhs tend to associate Sikhs' turbans with Osama bin Laden, Sikhs with turbans have become a superficial and accessible proxy for the perpetrators of the 9/11 attacks. As a result, turbaned Sikhs in America have been victims of racial violence and have had their identity challenged by calls for immigrant groups to assimilate into Western societies.This essay examines how the turban has transformed from a sacred piece of attire for Sikhs to a target for discriminatory conduct and an object of marginalization after 9/11. Part I provides an introduction to Sikhism, which originated in 17th century South Asia, and discusses the religious significance of the Sikh turban. Part II examines incidents of discrimination in several contexts involving turbaned Sikhs in America. Part III analyzes the debate surrounding assimilation that has been taking place in the West, which implicates conspicuous articles of faith, including the Sikh turban. The essay also explores the legal remedies available to turbaned Sikhs affected by discriminatory conduct or by broader policies on the wearing of turbans.The essay discusses the post-9/11 backlash as it relates to Muslims, Arabs, and South Asians. It attempts, for the first time, to report on Sikh concerns, which, until now, have largely been subsumed in broader discussions of the post-9/11 climate.
In recent years, the cost of delivering health care in developed and developing countries has been rising exponentially. Governments around the world are searching for alternative mechanisms to reduce costs while increasing the capacity of social programmes with significant investments in infrastructure. A number of jurisdictions have begun to utilise public-private partnerships (PPPs) as a means of achieving these objectives. The use of PPPs in the Canadian health system is a relatively new phenomenon. Generally, the success of PPP projects is evaluated on the basis of the qualitative outcomes of the project, most commonly in a value-for-money analysis.
This paper draws on two conceptual frameworks, therapeutic landscapes and postcolonial theory, to discuss aspects of medical tourism not addressed in extant literature. Building on the intersection between postcolonial and therapeutic landscapes scholarship, it highlights inequalities related to the production of national therapeutic landscapes located in postcolonial regions as well as their discursive (re)positioning as medical tourism destinations. As a framework, therapeutic landscapes can facilitate an understanding of medical tourism sites as curative spaces which combine modern and alternative forms of medicine with travel and leisure. Postcolonial theory critiques the economic, moral and cultural tensions emerging from the intersection between corporations that provide cheaper and more attractive medical services, and the nations on the periphery struggling to offer high medical standards that may not be accessible to their own local populations. In an effort to enhance scholarship on medical tourism, these conceptual frameworks are offered as points of departure, rather than sites of arrival, through which critical dialog on medical tourism can be sustained and broadened.
REIMER-KIRKHAM S, SHARMA S, PESUT B, SAWATZKY R, MEYERHOFF H and COCHRANE M. Nursing Inquiry 2012; 19: 202–212 Sacred spaces in public places: religious and spiritual plurality in health care
Several intriguing developments mark the role and expression of religion and spirituality in society in recent years. In what were deemed secular societies, flows of increased sacralization (variously referred to as ‘new’, ‘alternative’, ‘emergent’ and ‘progressive’ spiritualities) and resurgent globalizing religions (sometimes with fundamentalist expressions) are resulting in unprecedented plurality. These shifts are occurring in conjunction with increasing ethnic diversity associated with global migration, as well as other axes of difference within contemporary society. Democratic secular nations such as Canada are challenged to achieve social cohesion in the face of growing religious, spiritual and ethnic diversity. These challenges are evident in the high-paced, demanding arena of Health care. Here, religious and spiritual plurality enter in, sometimes resulting in conflict between medical services and patients’ beliefs, other times provoking uncertainties on the part of healthcare professionals about what to do with their own religiously or spiritually grounded values and beliefs. In this paper, we present selected findings from a 3-year study that examined the negotiation of religious and spiritual pluralism in Health care. Our focus is on the themes of ‘sacred’ and ‘place’, exploring how the sacred – that which is attributed as special and set apart as it pertains to the divine, transcendence, God or higher power – takes form in social and material spaces in hospitals.
Emergency departments (EDs) face problems with crowding, delays, cost containment, and patient safety. To address these and other problems, EDs increasingly implement an approach called Lean thinking. This study critically reviewed 18 articles describing the implementation of Lean in 15 EDs in the United States, Australia, and Canada. An analytic framework based on human factors engineering and occupational research generated 6 core questions about the effects of Lean on ED work structures and processes, patient care, and employees, as well as the factors on which Lean's success is contingent. The review revealed numerous ED process changes, often involving separate patient streams, accompanied by structural changes such as new technologies, communication systems, staffing changes, and the reorganization of physical space. Patient care usually improved after implementation of Lean, with many EDs reporting decreases in length of stay, waiting times, and proportion of patients leaving the ED without being seen. Few null or negative patient care effects were reported, and studies typically did not report patient quality or safety outcomes beyond patient satisfaction. The effects of Lean on employees were rarely discussed or measured systematically, but there were some indications of positive effects on employees and organizational culture. Success factors included employee involvement, management support, and preparedness for change. Despite some methodological, practical, and theoretic concerns, Lean appears to offer significant improvement opportunities. Many questions remain about Lean's effects on patient health and employees and how Lean can be best implemented in health care.
The discipline of geography is largely absent in discussions and debates about drug use practices and their relationships to sexual health. Given the important relationships among the use of drugs, performances of sexualized identities, and the practices of sex, it behooves medical and health geographers particularly, and social and cultural geographers more generally, to engage in the wider interdisciplinary debates about these relationships. Through a discussion of one drug, Viagra, this brief intervention offers an agenda for studying the geographies of sex, sexuality, and drug use. It is argued that drug use is an inherently geographic practice that reshapes how places are resituated in relation to the fluid and dynamic meanings of sex, sexuality, and sexual health, areas of research and practice that medical and health geographers ought to consider more seriously.
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Religious diversity and international migration: national and global dimensions
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The practice of medicine and prejudice in a new England Town: the founding of Mt. Sinai hospital, Hartford, Connecticut
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Masculinity in Sikh Visual Culture: Representing the Guru and the Martyr
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