Drawing on research conducted among patients in Ireland, this article examines the narrative constructions of chronic kidney failure and explores the ways in which patient narratives cross-cut and subvert modernist medical constructions of transplantation as a therapeutic outcome, an endgame, a "gift of life." In experience, patients dismantle this construction structure by emplotting their stories around the painful lack of an ending, ardently brought to bear by the lived realities of immunosuppressant drug therapy, the silent fears of graft rejection, and the isolation of recipiency. They articulate, instead, stories that disclose a multi-directional flow between past and future therapeutic interventions, between the altering nature of the renal body and personal experience. These storied dimensions are phenomenologically embedded in the sensory and temporal aspects of this condition as essential elements of chronic illness and as organizational properties of patient narratives.

BackgroundChronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT.MethodsThe article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings.ResultsIn the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information.ConclusionsExamining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

This paper explores the lived experiences of End Stage Renal Failure. It charts the experiential shifts across the trajectories of this chronic condition and investigates a phenomenological re-creation of body and realignment of self. Meaning is culturally produced, mediated by body and senses, illuminating the relationship between self and society. The point of departure for this paper is not the established criteria of diagnosis, but that of sensation, situating the locus of human meaning within a more localised explanatory nexus, the sentient body. It is from this point onwards that lived experiences of renal failure are 'emplotted' through telling and retelling the human condition of illness. Processes of medical intervention and alterations in sensory experience characterise much of this condition. They are exempli ed by the re-construction of the body/self through diagnosis, the impact of the ' stula' in preparation for dialysis, the temporary suspension of life on dialysis and the massive implications of transplantation on issues of physiological and personal sovereignty, in particular, the dramatic changes it brings to understanding the re-construction of the self in relation to an alien 'other'. At times, these events are narrated as part of a life-process, a coherent trajectory of illness experience. At other times, they are expressed as events ricocheting the person backwards and forwards, where the predictability of the past and the future has become complicated through the experience of rejection or threat of death.

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In recent years, tobacco research, as a field of investigative practices, has come to be seen as a major contributor to broader tobacco control efforts and a 'significant component of the global health agenda' (World Health Organization (1999). , questions remain about what the exact nature of the relationship between tobacco research and tobacco control should be. Guided by that central question, this article draws attention to recent attempts to define this relationship, in particular that embodied in the Global Tobacco Research Network (GTRN), in order to facilitate debate on how such definitions attempt to shape the research agenda. Throughout, the main critical focus will be the attempt to generate characterizations of the field, through entities like the GTRN, which relate tobacco-related research practices vis-à-vis their relationship to tobacco control. It is argued that such characterizations present a distorted and oversimplified picture of how we might assess the empirical work we find across the field as a whole. Tracing these difficulties back to the narrow normative position embodied within the GTRN and World Health Organization approach to tobacco research, the article concludes by arguing that there is a need to recognize, rather than correct for, the overlapping and diverse bodies of work which the study of tobacco-related questions has helped establish.