Breathing and Breathlessness: Chronic Obstructive Pulmonary Disease in Uruguay

Abstract

An increasingly common part of being human is living with chronic health problems for which management over time, and not cure, is the goal of medical treatment. One such chronic condition is chronic obstructive pulmonary disease (COPD), a lung disease caused by breathing-in smoke, dusts and chemicals, including tobacco smoke. This ethnographic study set out to explore how COPD is lived with and cared for in Uruguay, where rates of COPD are amongst the highest in South America and where most cases go undiagnosed. The aims of the research were to explore the following questions: a) what does it feel like to be breathless and how is COPD experienced within family and healthcare relationships? b) how is the lived-experience of COPD shaped by cultural, social, economic and political contexts? And, c) what are some of the challenges and opportunities for preventing and treating COPD? The objective of this ethnography is to contribute a unique case study to the anthropological literature on chronic illness both in terms of the disease under investigation and the cultural context. The thesis responds to a call in the literature for more sophisticated phenomenological approaches. By incorporating a multitude of field methods into ethnographic fieldwork I combine a sensorial medical anthropology approach and a political-economy of health perspective. The ethnography begins with a cultural and sensorial analysis of breathing and breathlessness in Uruguay in order to situate the expressions of this disease across a diverse group of participants. I argue that the experience of COPD is shaped by healthcare systems and inequalities and highlight two healthcare contexts where space is made for people to socially interpret sensations in the body. The thesis culminates in the critical assessment of public health goals and makes recommendations for improving COPD prevention and care in Uruguay.