The Age of Surveillance Capitalism, along with additional sources not ordinarily referenced in the social work literature, the article examines some of the economic and political imperatives that are driving forward new surveillance practices. The aspiration is to provide conceptual coordinates enabling practitioners, educators and those receiving social work services to arrive at a theoretically expansive sense of what may be occurring across a societal canvas. The focus is on a cluster of five enmeshed themes: first, what Zuboff means by ‘surveillance capitalism’; second, why this form of capitalism has appeared so quickly over the past couple of decades; third, what the tech corporations, such as Google, seek to achieve; fourth, how surveillance capitalists aim to eliminate chance by refining technologies so as to try and constitute us as predictable human subjects; fifth, the trajectory of surveillance capitalist interventions and how they are ‘doubling down’ on the processes of data extraction. Zuboff’s book was completed prior to theCOVID-19 global pandemic and, in the latter part of article, it is argued that the current crisis will result in new forms of surveillance becoming socially embedded.Drawing on Shoshana Zuboff's (2019)  British Journal of Social Work draw attention to the impact of technology , surveillance capitalists have also been adept at appropriating a lexicon of, seemingly, benign social work keywords  so as to nurture a particular affective ambiance tapered to entice and retain users for the purposes of data extraction . A good Here, it is vital to recognise that the neo-liberal zeitgeist furnishes a temporal and cultural context for the evolution of ‘surveillance capitalism’ with the main CEOs and associated key players broadly adhering to the key ideological tenets of this particular regime of capital accumulation. During the initial months of the COVID-19 pandemic, the leading surveillance capitalist CEOs experienced an extraordinary wealth ‘surge’. The US-based In terms of ideology, Without downplaying the role played of Facebook, perhaps it is Google, created in 1998—and now corporately parented by Alphabet—that is surveillance capitalism’s iconic corporation. Maybe there was a ‘time when you searched Google’, avows For capitalism to function, the scale of consumption has to be maintained or else there will be a block in the system. In short, commodities have to be produced, but they also have to be purchased. Hence, there is a need to entice and persuade people to constantly ‘extend the circle of their enjoyments’ , p. 769.predictable human subjects. Central here is the drive to embed certainty and outcomes that are guaranteed on a societal basis. This involves the design of a multiplicity of programmes intent on behaviour modification in order to render our futures entirely predictable; particularly in terms of what we choose to buy and how we relate to each other within the wider fabric of capitalism. For the sake of the ‘plan, the totality of society—every person, object, and process—must be corralled into the supply chains that feed the machines’  notes, the capital accumulation process is an ‘endless process’ with capital constantly crashing through what have previously been seen as a ‘barrier’. This point, made in the middle of the nineteenth century, adds to Zuboff’s discussion on the expansion of the ‘extraction architecture’ of ‘surveillance capitalism’. Influential figures, such as Schmidt and those sharing his imperatives, hanker to create a new apparatus in which ‘world, self, and body are reduced to the permanent status of objects…His washing machine, her car’s accelerator, and your intestinal flora are collapsed into a single dimension of equivalency as information assets that can be disaggregated, reconstituted, indexed, browsed, manipulated, analysed, reaggregated, predicted, productized, bought, and sold: anywhere, anytime’ , p. 210.The creation of this new apparatus is envisaged as occurring on two fronts: by geographically extending operations into ‘real-world’ domains lying beyond the computer or other devices such as the smartphone and by increasingly mining the human body for data . The extAlthough not explored in detail by Zuboff, so-called ‘smart dust’ may well be an area of technological expansion and commercial exploitation in the next few decades. Coined in 1997, the term refers to networks of microelectromechanical sensors, or ‘motes’, which will ‘unlock unprecedented levels of data collection’ . These mIn the area of health and social care, researchers have also raised the possibility of ‘neural dust’ being implanted in the body and used to monitor the activity of different organs and to stimulate nerves and muscles . More geBy 2015, 29.5 million US adults used wearable devices—mostly fitness trackers such as Under Armour’s and smart watches , p. 603.Bodies can also, of course, be tracked using global position system data. Derived from military intelligence practice, Google is at the forefront of commercial location tracking , p. 242.The surveillance capitalist sector appears particularly interested in how the human voice, so central to social work interactions, might increasingly become a source for data extraction. That is to say, there is a realisation that human conversations are a medium which can be harnessed to the extractive apparatus. This realisation can be connected to how private living spaces are increasingly evolving into rich sources of data. Purporting to conjure into being the so-called ‘smart’ houses, home automation systems, such as Amazon Echo and Google Home, ‘render rivers of casual talk from which sophisticated content analyses produce enhanced predictions that “anticipate” your needs’ , p. 260.As mentioned in the article’s Introduction section, a growing field of data analysis—that may well become more prominent in social work in the future—is variously described as ‘affective computing’, ‘emotion analytics’ and ‘sentiment analysis’ , p. 281.These companies are, of course, small in size when compared with the tech giants and we also need to be mindful of the fact that much of this ‘science’ is unproven and that perhaps the publicity speaks, more of the success of entrepreneurs and corporate hucksters in marketing their wares and ‘charms’ , p. 287.It is not difficult to detect how some of the concerns, articulated by Zuboff, become extraordinarily magnified in the context of the COVID-19 global pandemic . PromineQuestions relating to ‘race’ and racism are largely absent in Zuboff’s book and, indeed, there this is a more pervasive lacuna within the academic field of ‘surveillance studies’. Nonetheless, black bodies are frequently targeted for particular types of oversight and scrutiny , 2021. IAided by the expertise of the surveillance capitalist corporate sector, states have been able to repurpose habits and ways of relating to the ubiquitous smartphone. For example, in Poland, smartphones have been used to enforce quarantine with individuals mandated to remain at home being compelled to send a photograph of themselves within ‘twenty minutes of receiving a prompt from government officials’ ; if thiset al., in The signatories of a In the People’s Republic of China, the Alipay Health Code system assigns individuals differently coloured codes on the basis of COVID-19 status , p. 14. hypothetical government that demands that every citizen wears a biometric bracelet that monitors body temperature and heart-rate 24 hours a day…The chains of infection could be drastically shortened, and even cut altogether. Such a system could arguably stop the epidemic in its tracks within days…Even when infections from coronavirus are down to zero, some data-hungry governments could argue they needed to keep the biometric surveillance systems in place because they fear a second wave of coronavirus, or because there is a new Ebola strain evolving in central Africa .Whilst recognising the advantages conferred by currently heightened forms of technological monitoring in containing contagion, Certainly, there are a bundle of complex themes emerging with relate directly to social work concerns circulating around human rights, inclusivity and access. For example, if digital methods continued to be deployed and become extended, what of those (frequently older and low income citizens) who lack smartphones? . Some stAs Whilst not dwelling on social work practice to any large extent, the modest aspiration is of this article has been to provide a number of theoretical coordinates, which might enable practitioners, educators and those receiving social work services to potentially arrive an enlarged sense of what may be taking place. That is to say, the aim has not been to establish deep connections with the micro and quotidian aspects of social work practice; rather the emphasis has been on illuminating a conceptual framework, which has yet to be explored in the social work literature. Others may, of course, wish to build on this analysis to address particular facets of social work that are inflected by the dynamics of neo-liberalised forms of surveillance. Indeed, many years ago, the ground-breaking research of Donna The Age of Surveillance Capitalism, the spark for this discussion, is weighed down with conceptual problems, but exploration lies beyond the scope of the article. Zuboff can, however, contribute to our comprehension of what is taking place. Surveillance is not intrinsically repressive and it is vital to recognise that the technologies deployed to monitor and prevent political dissent, for example, can be utilised by those targeted. Human rights activists have used sophisticated tracking and monitoring techniques to try to safeguard the lives of those penetrating hazardous US borders from the Global South (al South . Also inal South . Similaral South .However, technological innovations are not generally used as instruments intent on facilitating progressive ‘social change and development’ . This is


Breast cancer has the highest incidence among all cancers for women in Taiwan. The current screening policy in Taiwan provides biennial mammogram tests for all women aged 45 to 69 years. A recommendation for further investigation is sent via post to women with a BI-RADS result of 0. The proportion of women who followed-up with a recall request for further investigation after an abnormal mammogram has been below 92.5% in recent years. Therefore, we aimed to explore the experiences of these women who refused recall for further investigation despite an abnormal mammogram. Purposive sampling was conducted on 13 women who refused recall for further examination of abnormal screening mammograms. Data collection included inductive, in-depth interviews or telephone interviews. A content analysis was applied. Three themes were identified: (1) negative screening experiences, (2) struggling with ’to go or not to go’, and (3) rationalizing without a follow-up examination. The first theme included three subthemes: (1) pain of examination, (2) the inconvenience of medical treatment; waiting, and (3) dissatisfaction with having to pay for further examination. The second major theme included three subthemes: (1) perceiving one’s susceptibility to breast cancer as very low, (2) questioning the accuracy of the results, and (3) procrastinating with a “head-in-the-sand” mentality. The third major theme included two subthemes: (1) fatalism and (2) paying attention to self-cultivation. In conclusion, the findings provide important information to healthcare providers involved in case management related to the actual living experiences of women with abnormal screening mammogram results and the additional education required to raise breast cancer awareness in the general public to achieve overall caring goals. Breast cancer is the most common cancer in women worldwide. In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally . In TaiwComplete and effective screening must be carried out when abnormal results are found in a public screening. That is, patients with abnormal screening results must continue to receive follow-up diagnosis and follow-up treatment arrangements to achieve the purposes of early detection and early treatment of cancer. According to the Health Promotion Administration of the Ministry of Health and Welfare in Taiwan, about 1,470,786 women received a screening mammography in 2018–2019, which is a screening rate of 40% .Several studies have proposed methodologies to promote screening mammography ,11,12, tA qualitative study approach was used to understand the experiences and individual perspectives of women, as well as their attitudes, situations, expectations, and suggestions for refusing the recall for further investigation of abnormal breast cancer screening results. Purposive sampling was used to recruit women who met the following criteria: (1) screening mammography at the Health Promotion Administration, Ministry of Health and Welfare, in 2016–2017 with a BI-RADs category result of 0, (2) refusal of recall for further examination of abnormal breast cancer screening, and (3) voluntary agreement to participate in this study. All study participants provided informed consent during individual or telephone interviews. The exclusion criterion was a BI-RADs result of 4.Data collection consisted of semi-structured interviews to determine the participant’s reasons for refusing the recall for further investigation of an abnormal breast cancer screening result based on the following questions: (1) What did you think when you were informed about an abnormal breast cancer screening report via postal mail or a telephone call from the nurse? (2) So far, since receiving the abnormal report, you have not had a follow-up examination. How do you deal with it? (3) How did the nurse communicate with you and explain the abnormal report? Do you have any suggestions that would make more women willing to return to further examinations? and (4) Based on your mammogram screening experience, how do you think the service can be improved? Data collection was conducted from October to December 2018. None of the participants withdrew from the study. Data collection was completed using the data saturation criterion through the repetition of information in the statements from a total of 12 telephone interviews and one in-depth interview. The interviews ranged in length from 45 to 60 min.All audio-recorded interviews were transcribed verbatim and analyzed by all authors using content analysis . The anaThis study was performed in accordance with the principles of the Declaration of Helsinki. All the study procedures were approved by the Hospital Human Investigation Committee at each of the medical centers (IRB No. CE18055B). The participants’ rights of anonymity, confidentiality and withdrawal from the study were explained at the time of the interview. During the analysis of the interviews, three specific themes emerged: (1) negative screening experiences; (2) struggling with ’to go or not to go’; and (3) rationalizing without follow-up examination .This theme refers to a series of negative reactions to the prior examination when a woman receives a positive notification of breast cancer screening. When women express their own screening experiences, they will recall the overall process of screening and follow-up. A mammogram is an X-ray examination of the breast. About 53.8% of women may feel pain during the procedure, while others may feel the pain is tolerable. Each breast fits onto a flat X-ray plate. A compressor then pushes the breast down to flatten the tissue. This provides a clearer picture of the breast.As the 64-year-old case G exclaimed: “It was so painful! I don’t know why this examination has to squeeze my breast so bad! This is terrible! I don’t like it!”As 58-year-old case M stated, “I was very uncomfortable during the examination. It was terribly painful, and it hurt constantly for two weeks. It really hurt! It was really painful. I really don’t want to do this examination ever again!”If provided options, they would refuse to do a mammography, as 68-year-old case A said: “If you want me to do that squeezing examination (mammography), you don’t need to call me anymore! It was very painful!”, “This brings me back to the very first time, when I experienced the same pain!”When women receive a positive breast cancer screening notification, they often recall their negative experiences of the past, especially the time spent waiting for the examination at the hospital. For example, 66-year-old case B, who had had colon cancer more than ten years previously, mentioned:“I don’t want to go to the hospital anymore, I’m so scared!…I waited and waited the whole morning for the doctor to see me for only 2 or 3 min…”Some patients choose to give up because of the long waiting times at the hospital. For example, 58-year-old case M said: “I have registered at the other General Hospital for the further check-up (ultrasound examination), but it requires a lot of steps and time to wait until my turn in the afternoon, so I did not want to wait anymore.”As 68-year-old case A, who is illiterate and lives alone, said:“The mobile mammography vehicle is very convenient for time! Normally, you have to go to the hospital for a long time to queue up for this examination. Visiting the hospital for an examination is a lot of trouble for me.”Unlike the screening, which was free, women who were recalled for further examination of an abnormal breast cancer screening have to pay their own medical bill. Some participants expressed strong dissatisfaction with this situation. For example, case G said:“Breast cancer screening is a free service. Why should I have to pay for further examination with my own money? This is terrible. Plus, during the mammography, the squeezing hurt so much; it was very uncomfortable. And now I need to pay for an examination!?! I can’t accept it. Who would be willing to do it?”If the further examination cost them money and their personal time, they would choose not to attend the follow up. As noted by 56-year-old case L:“You keep calling and telling us to go back for further examination. It makes people wonder if there is any problem. So I try to cooperate with you and follow your instructions, but the problem is…I have to pay for this on my own…do you know what I mean? I’m not happy about this.”After receiving an abnormal breast cancer screening report, a woman will subjectively consider her own or others’ medical experiences, such as consciously thinking it should be fine, being asymptomatic, having no family history of breast cancer, and finding no lumps during self-examination. They may even consider the medical report a false positive. All these reasons support “not going” for a further examination. Medical experiences and treatments that might support “going” for a further examination are awareness of breast cancer threats and others’ experiences.Struggling with a decision on whether ‘to go or not to go’ to a hospital for further examination can lead to repeated and tangled thoughts. When faced with the question of ‘to go or not to go’ for further examination, there are three kinds of psychological struggles, which are as follows:After receiving notification of an abnormal report, some women may not return to the hospital in time for a further examination for several reasons. These reasons may be that they do not feel any threat to their health, their own self-examinations revealed no lumps or hard masses, they have no abnormal symptoms, they feel healthy, and they have no family history of breast cancer. As a result, they do not return to the hospital in time for a follow-up.A total of ten of the thirteen (76.9%) participants reported that they did not have any abnormal breast cancer symptoms currently. Two had a history of benign breast-related disease and one had had colorectal cancer.Case D viewed the abnormal report as not serious. She said, “I didn’t feel anything hard…nothing. I think I’m fine. Also, I’ve received a recall notification before, so I’m not nervous at all.”Case E said, “Because I have done it before, there are reports of abnormalities just like before, so I am not nervous at all. It is no different from before.”Although Case B had a ten-year history of colorectal cancer, she was not willing to be re-examined this time. She stated that the examination more than a year before had been benign and she did not want to be re-examined.Case C felt that she usually conducted self-examinations without feeling any lumps, and said, “I did not return to the hospital for re-examination because I don’t think there is anything, and I can’t feel anything! When I take a bath, I check them. Breasts sometimes have size, not necessarily that there is a problem with size!”About three quarters (76.9%) of the women expressed that they had neither symptoms nor discomfort, so they did not want to be further examined. As case M said, “However, I have no symptoms yet, and so far there is no discomfort…” Although a person with a family history of breast cancer should be regarded as having a high risk of breast cancer, two women whose sisters had had breast cancer still consciously felt that they were in good health and did not have cancer.Many participants wondered if, with so many cases receiving a follow-up consultation report, was there a real problem? For example, Case D thought, “Is there really a problem or something? Then why didn’t you tell me directly? If there was really a problem (here and now during the check), why can’t we just talk about it directly? I also question whether there is something wrong with the screening process or the machine itself, and it’s not that our bodies are abnormal”. Case L said, “It may be that the scanning process of your mobile mammography vehicle is not as good! So it may have these phenomena. And the scanning time is very long, and the result is still not good. I don’t want to do mammography the next time.”Case G also had the same experience. She claimed that “the machine did not do it accurately.”After receiving the notification of abnormal breast cancer screening, women may consult their family members for their opinions and ideas, and they will also refer to the similar experiences of others around them to gauge whether they want to be followed up and return to the hospital for re-examination. Women eventually chose not to undergo a follow-up examination.As Case D stated, “I asked my classmate whose wife works in a hospital. He said you still have to check it, but I think it is probably a lipoma, so it’s not that serious.”Case K, whose husband had been urging her to go back to the clinic for re-examination, said, “My husband has been pushing me. He urged me three times and four times”. Then she said, “I also know in my heart that it must be checked. I would like to say something bad, and I would also like to say that it probably is not that serious, anyway, it is a contradiction!”When the women did not follow up and get re-examined, they would adopt either fatalism or a health regimen, and their own prescriptions, to allow themselves to accept and face it rationally.life is impermanent and everything is bearish; life and death are set by fate, and one should let nature take its course.Whenever people face an unexplainable life phenomenon, they naturally choose a rational explanation, and they may be accustomed to attributing events to fate. Such a mindset can allow them a certain degree of comfort when encountering possible abnormal breast screening results. To alleviate the suffering in life and maintain a calm happiness, women will adopt “fatalism” to explain their own outlook on life. Their fatalism includes the ideas that As Case C pointed out, “Everyone will die. Don’t be afraid. When you are happy, our condition will not worsen. It will repair our immune system. And everyone has cancer cells in their bodies, it’s just whether they have attacked or not.”The women mentioned that life and death are natural phenomena. People cannot control life and death, or whether they become sick or not. It is an arrangement of God’s will. Therefore, excessive fear, worry, and even anxiety are useless. It will increase your troubles and unhappiness. Case A, who had the same experience, also said, “You have to leave the world when the time is up anyway.” Case J said, “If I have , then the health check will be fine. If I really have cancer, it will be life and death.” In addition, Case A still hasn’t been re-examined and said, “I see it very openly. People come to live in the world. It’s useless to think so much. I think it’s good to pay attention to body care and exercise.”The participants used folk remedies suggested by their family members and started taking them after the breast screening to avoid breast cancer in the upper body, or they used their own health care methods, diet choices, exercise and other methods in order to maintain their health.Case A said, “I myself take Chinese medicine to maintain my body. When I received a positive follow-up call after mammography, I bought Chinese medicine to take, and I felt it was effective after taking it.” Case C mentioned the anti-cancer lifestyle, or living happily. She said, “Why haven’t so many cancers attacked? This means that he may live his life happily. So a person’s mood is very important.” Case M used Chinese medicine to maintain her health, saying, “Because my family is also a family of Chinese medicine, I know the prescriptions for cancer. There are breast cancer prescriptions for breast cancer and also prescriptions for colorectal cancer. I have relied on Chinese medicine to regulate my body since I was a child.”To our knowledge, this is the first study to adopt a qualitative approach to explore the experiences of women who refused recall for further investigation of abnormal screening mammography results. Many studies have discussed the psychological consequences of false-positive screening mammograms ,25,26,27According to the experience of the screening site, since mammography is an imaging examination that uses low-dose x-rays to image the breast tissue, the mammogram is taken through a special machine that involves compression and squeezing. This examination process causes pain and discomfort, but it can be used to detect calcification points or tiny tumors in the breast, or to find asymptomatic zero-stage breast cancer. Something similar was reflected in the study by Kornguth et al., who found that a large proportion (up to 91%) of women report experiencing some degree of pain during mammography . AlthougWhen conducting a telephone follow-up, the nurse must first explain the costs that may be incurred during the re-examination and return to the clinic, and each must be clearly explained. If the patient does not return to the hospital for re-examination and follow up, the nurse will actively provide “referral” related tasks to assist the patient to go to the medical institution of her choice or near her home for reexamination and tracking. After that, the patient can take the current mammography CD-ROM sent by the hospital with the referral triplicate to the medical institution of choice for reexamination. In this way, the patient can also reduce her medical expenses . In addition, it may also reduce the cost of treatment. It takes a long time to go to the medical center for treatment. In addition, it is important to consider whether there are other, friendlier medical treatment measures that can replace the exemption measures, reduce the negative feelings of the patient, and increase the willingness of the patient to return to the hospital for review and follow up.The pull between “not going” and “going” for a re-examination shows that the perceived threat of breast cancer is low, which is similar to the results of Kuo et al. , if the Regarding rationalizing without follow-up examination, when women do not attend a follow-up examination, they may adopt fatalism and pay attention to self-cultivation methods so that they can accept and face their disease rationally. Chinese fatalism is the most common, including the impermanence of life. This is the same as the findings in other research in Taiwan ,34. ThisThis study had several limitations. The first was the small sample size. Only 30 women met the inclusion criteria. Of these, only 13 women were willing to be interviewed by telephone, and they were not willing to give face-to-face interviews. Only one participant was willing to meet face-to-face for the interview. The second limitation was the interview mode, which may have affected data collection. It is not easy to detect non-verbal expressions and body language in a telephone interview, and it is also easy to be interrupted by factors in the surrounding environment. The final limitation was that we excluded BI-RADS 4 follow-up cases, because different treatments produce different levels of anxiety and experiences. Future studies could incorporate BI-RADS 4, and even BI-RADS 3 and 5, to understand why the women did not undergo further follow-up examinations.The study results showed that women with abnormal mammography screening but no follow-up examination perceived the risk of breast cancer as low (76.9% of respondents) and found the examination painful (53.8% of respondents). Therefore, we need to improve their understanding of breast screening knowledge and reduce the physical pain of the procedure.The women also expect to be understood and supported, which is also a possible factor that promotes their willingness for follow-up. If screening nurses can demonstrate effective professional communication skills and understand their feelings, thoughts and attitudes, it will help nurses to improve their understanding of these women and how to reduce their negative experience as a strategy to increase follow up visits.


Introduction: In most sub-Saharan African countries iron deficiency anaemia remains highly prevalent in children and this has not changed in the last 25 years. Supplementation with iron hydroxide adipate tartrate (IHAT) was being investigated in anaemic children in a phase two clinical trial (termed IHAT-GUT), conducted at the Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine (LSHTM) (abbreviated as MRCG hereof). This qualitative study aimed to explore the personal perceptions of the trial staff in relation to conducting a clinical trial in such settings in order to highlight the health system specific needs and strengths in the rural, resource-poor setting of the Upper River Region in the Gambia. Methods: Individual interviews (n = 17) were conducted with local trial staff of the IHAT-GUT trial. Data were analysed using inductive thematic analysis. Results: Potential barriers and facilitators to conducting this clinical trial were identified at the patient, staff, and trial management levels. Several challenges, such as the rural location and cultural context, were identified but noted as not being long-term inhibitors. Participants believed the facilitators and benefits outnumbered the barriers, and included the impact on education and healthcare, the ambitious and knowledgeable locally recruited staff, and the local partnership. Conclusions: While facilitators and barriers were identified to conducting this clinical trial in a rural, resource-poor setting, the overall impact was perceived as beneficial, and this study is a useful example of community involvement and partnership for further health improvement programs. To effectively implement a nutrition intervention, the local health systems and context must be carefully considered through qualitative research beforehand. Iron deficiency (ID) poses one of the most significant public health burdens today. At any given moment, more individuals suffer from ID than any other health problem, with an estimated 1.24 billion affected individuals worldwide . In Sub-Despite widespread supplementation schemes, ID prevalence has not changed much in LMICs over the last 25 years ,7,8,9. OWhile integrating nutrition-specific interventions into health systems can be impactful for both health and nutrition outcomes, different countries will have specific delivery needs for implementation . Until tGiven the state of healthcare and disease prevalence in LMICs, clinical trials are well received, and participant recruitment is often easier than in a health secure country ,21. The Difficulties of conducting clinical trials in LMICs stem from limitations in obtaining informed consent, ethical compensation mechanisms, poor health infrastructure, socio-economic and cultural differences , and lacThe aim of this study was to: qualitatively explore IHAT-GUT trial staff perceptions of barriers and facilitators to conducting this clinical trial to highlight the health system specific needs and strengths in a rural and resource-poor setting. IHAT-GUT was conducted on children with anaemia between the age of 6 and 35 months, living in The Upper River Region (URR) of the Gambia . The chiWe describe the involvement of research staff in the iron supplementation trial IHAT-GUT , which wIndividual interviews were conducted with 17 IHAT-GUT local trial staff . Trial sData was collected in person by the first author (IS). Participants chose the location of the interviews to facilitate a more comfortable environment. Locations included the MRCG in Basse and Fajara and study sites within the URR. A topic guide (available upon request) was developed and used to facilitate discussions. Interviews, with informed consent, were audio recorded and later transcribed verbatim. Photographs were taken during data collection with informed consent. Interviews continued until no additional insights were gained .Transcripts were analysed using inductive thematic analysis to explore patterns in the data . Braun aAn inductive approach was used whereby data analysis was data driven so that participant’s views took precedence over the interviewer’s previous knowledge or beliefs . That saEthical approval was obtained from the Gambia Government/MRC Joint Ethics Committee (REF: L2018.25) in June 2016. The study was conducted in accordance with the Declaration of Helsinki. Written and verbal informed consent for interviews and photographs was obtained from each participant. It was made clear that refusal to be involved would be confidential and would not affect their work; no participants refused to be interviewed.A distinction was made between barriers and facilitators at three levels: study participant, trial staff, and trial management. The barriers included community factors and low incentivisation (participant level), motivation (staff level), and country context  . Illustrpass the messages [to the communities] smoothly, so everyone can understand. If your communities understand you won’t have problems… with sensitisation go through the hierarchy: the village level, then compound level, then houses, then individuals”. Another community norm is that mothers often stay home and mind the children and household, but during IHAT-GUT, mothers and children had to attend clinic once a week. The Data Manager stated: “There’s also a bit of cultural problem… because in Africa we believe the wife stays home to cook, clean. So, some husbands decide (to) have their wives stop going to the clinic visits”. The issue of husbands not wanting their wives to leave home to attend clinic visits was a barrier to participant recruitment, but with appropriate informed consent and village hierarchical involvement, this was overcome. Many viewed specific cultural factors as barriers to successful running of this trials, specifically community hierarchies and education. These issues posed challenges with community sensitisation for the staff, but it was noted that these barriers were easily overcome if approached properly. Regarding hierarchies, the Local principal investigator (PI) noted that to run the trial fluidly it was key to “The level of awareness, literacy and education here is a challenge because you want to be sure that the people you are conducting research on are aware of what your study is about and what the implications are” (Research Clinician). Another barrier was the misunderstanding about blood sampling. State Enrolled Nurse 1 pointed out that some parents were reluctant for their child to join the trial (and others withdrew) when they learnt blood drawing was involved . To overcome this barrier, IHAT-GUT used village sensitisation to inform all villagers about the trial and of what it consisted. Community education levels were believed to impact the communication of trial information. While many men attend secondary school, women often leave school during puberty to start a family. The low level of education was viewed as a barrier to informing communities about the trial: “involved . This waWhen we do the venous bleeding, we give them (the mothers) 50 Dalasis (to buy breakfast), but I would love for it to be more than that. We take blood from these children, so we need to make life easy for them. Maybe they are on the drug that doesn’t do anything. The mothers sacrifice a lot for this project, so we need to give them something back”. State Enrolled Nurse 2 maintained that offering free medication and healthcare was an incentive to take part in the trial but moving forward researchers in other clinical trials need to consider incentives beyond the child’s healthcare: “There will always be challenges. That you should expect. The biggest challenge is working with individuals and managing individuals. Everyone has negative qualities, I have them”. Workload was also noted as a barrier by both the laboratory and data teams, as those departments “tend to be oversubscribed” (Statistician). The Analytical Project Manager commented that the workload became unmanageable for the laboratory staff at some points. Staff motivation was difficult for those with managerial responsibilities . Likewise, “IHAT-GUT is running its study where no study has been done in the past at this scale… during rainy season you have floods” (Nutrition Theme Administrator). The Research Clinician mentioned that: “The weather… it’s harsh, it’s quite hot, dusty, you get flooding”. It was also mentioned that: “You need to consider the environment and circumstance (they) are in a very robust area in the North Banks”  where “the villages are far, and the roads are poor” (Senior Field Worker). For example, “let’s say you’re living in a place like Kuwonkuba, they might not have electricity or clean water. This adds stress” (State Enrolled Nurse 1).The remote setting and harsh weather conditions required extensive planning and coordination: “The major challenges in running these trials here is… making all the necessary arrangements: approvals from the Ministry, Medicine Control Agency, Ethics and SCC (Scientific Coordinating Committee), establishing the sites of the studies. And of course, it requires a lot of logistical support in remote areas”. He also noted handling the “financial management” of various projects at MRCG in relation to context: “Always expect a project to overrun, so you adequately allocate expenditures. For example, in clinical trials, you always have SAEs (Serious Adverse Events)”. The associated expenditures due to the context also posed a challenge for the Field Coordinator: “It’s a problem… we are spending too much on the (ferry) crossing”. Likewise, transporting mothers from villages to clinics and transferring samples to the main laboratory facilities added financial stress. The Senior Field Worker noted funding needs such as giving “(phone) credit to call for the Field Workers and mothers” so they could afford to make trial related calls.The Nutrition Theme Administrator noted that the context made sticking to the tight project timelines challenging: “The facilitators included healthcare, incentivisation, and receptive communities (participant level); staff characteristics and education enhancement (staff level); and the local partnership  . IllustrIt’s better to give nutritional interventions where they are most needed”. This was echoed by the Senior Field Worker: “Especially IHAT-GUT because it helps the Gambian children and it’s the first one in the North Bank… We are working where they need it most...There was more anaemia, they had less hospitals. Medical care is lacking. Mothers say: ‘please come to our communities’”.The study was conducted in the North Bank of the URR where the poorest Gambian communities reside and the double burden of malnutrition and infection is highest . ScientiThese studies excite them. They want them to continue. We deal with the health, the management, the transportation.”Another advantage for trial participants was that healthcare was fully covered during the trial. The Nurse Coordinator found that local communities embraced these interventions: “You need to bring a social impact, so the participants feel valued (rather) than just coming to do what you want and not giving the mothers and children something”. A successful incentive was the provision of Yandi juice, which made supplement administration easier and more enjoyable for participants: “Giving the Yandi attracts the children because they want to take the drugs. When they see the Field Workers, they get excited” (State Enrolled Nurse 2). The Nurse Coordinator also mentioned how “sometimes the kids are running for the Fields Workers because they are excited for the juice” and advised to use this approach in the future.The Data Manager mentioned that: “The Gambians, they are remarkable people. They are the most amazing, welcoming people. It’s a very friendly environment to work in. It’s a research-friendly country”. State Enrolled Nurse 2 highlighted that URR, being a low resource setting, facilitated this: “The advantage of the project being run here is due to low-income earners, so having these projects is a big deal… They are very cooperative. In an urban area it would have been harder, but in a rural area they are excited”. The Data Manager echoed this sentiment and believed a similar trial in the UK would be more challenging. Staff found the communities were receptive towards the study. The Research Clinician, who is not Gambian himself, found: “In Europe, I don’t think it would be easy to conduct studies like this. In Africa, people don’t find it a problem that projects come in their communities. We are Gambian. When we go into our own communities, they are accepting”.It was very helpful that the staff going into the communities to conduct research were from a similar cultural background and could speak local languages. The Senior Field Worker highlighted: “The teams, the doctors, the researchers, the nurses and so on that we have here are second to no other country, so you know they can get good work here”. The Analytical Project Manager had the same confidence in his colleagues: “It’s also that they have people on ground who already have experience of running these clinical trials, both from the clinical aspects to the field staff. The people are experienced and consistent (…) they have had proper training about interacting with the community and attaining data from them”. The staff had strong experience and knowledge in working with research studies in rural Gambia. The Local Safety Monitor was confident that being part of this project meant having a high calibre of staff with education, knowledge, and experience: “(It’s) very important to me because it drives you to continue your work, you see the issues and the results and it’s inspiring to keep doing this work”. Having grown up in the Gambia, the Data Manager was proud to impact his country: “Growing up here, I’ve always seen malnutrition and poverty, so I’m conscious of my country’s state (…) you are contributing to change young people’s lives, which is just amazing”. Likewise, the Senior Field Worker found: “… I can contribute my part to help Gambian children”.Staff were highly ambitious for themselves and the development of their country. The Local Safety Monitor mentioned impacting West Africa through public health: “One thing I like in IHAT-GUT is the blood experience because it’s a learning experience”. One of The Statistician’s favourite parts of working with MRCG was their advancement of staff knowledge through training. Likewise, Scientific Officer 2 was able to complete her master’s because of MRCG. The staff felt valued by MRCG and IHAT-GUT, thanks to the knowledge that they gained and this enriched their work experience and dedication to the trials See . The FieMRC has a great track record here in the Gambia, they have cordial relationships with the communities and with The Gambian government and its ministries” (Nutrition Theme Administrator). The Field Coordinator noted that MRCG has an international research reputation: “They have a high regard in terms of quality research, and they have been in existence for almost 70 years” (See MRCG’s research unit has been in the Gambia for 70 years, giving them respect in the country for their long-standing establishment, advances in healthcare, and facilities for epidemiological studies and clinical trials. MRCG’s upstanding reputation with The Gambian Government and communities allowed easier collaboration and authorisation from the government: “ars” See . The Anaars” See . Clinical research in a LMIC, such as the Gambia, poses challenges. Barriers emerged in this study, such as mistrust regarding blood drawing. O’Neill et al.  looked aWhile LMICs were noted as lacking commercial ability, infrastructure, materials, and overall research capacity, elsewhere, this was not seen in the present study ,16,27. RMaterials can be difficult to resource in LMICs and for projects to run smoothly; advanced planning is needed. However, a lack of resources in LMICs increases the need for sound research to prioritise these limitations . This baThe overall impact for the country’s healthcare can be beneficial and outweighs the barriers described. Our findings are in line with previous research, noting the need for research in such communities ,21. ClinThe ease in recruiting patients was noted as a facilitator in running clinical trials in LMICs like the Gambia. LMICs offer an attractive setting for clinical trials as there is often less access to healthcare, so the prospect of healthcare through a clinical trial lends to shorter periods of participant recruitment . RecruitThanks to the local partnership and strong establishment of MRCG in the Gambia, the country is well equipped for incoming projects due to receptive communities, ambitious and knowledgeable locally recruited staff, and the research facilities and governance offered by MRCG. Locally recruited staff working in their own communities made communities receptive to the trial due to increased trust. It was previously reported that it was beneficial for clinical trials to utilise their local workforce because it allowed for the use of local knowledge . This maAnother highlighted facilitator in the trial, beyond just participant healthcare, was participant transportation to and from the clinic where the interventions took place. Mobility has been seen as a barrier for non-participation in a clinical trial in the Gambia ,29.A few limitations of this study warrant noting. Data was collected by a young white woman interviewing mostly older men. Broom et al.  found heThis study highlighted the barriers and facilitators to conducting this clinical trial in a rural and resource-poor setting. It brought to light that for clinical trials to be successful in such settings, cultural context must be carefully considered. Specifically, researchers should devote substantial time to engaging with the community to gain insight into pre-existing beliefs, knowledge, and awareness levels of the population, as well as the social structures at play.This study reported that the staff were proud of their high calibre of work and ambitious to continue making an impact on the country’s education and healthcare levels. While barriers were faced in running a clinical trial in this rural, resource-poor setting, the overall impact was perceived as beneficial, and this study is a useful example of community involvement and partnership for further health improvement programs. These findings highlight the value that staff find clinical trials add to their lives as well as the need for creating and nurturing local partnerships, which enables the continuous embrace and success of clinical research.


Tobacco mosaic virus (TMV) has served as a model organism for pathbreaking work in plant pathology, virology, biochemistry and applied genetics for more than a century. We were intrigued by a photograph published in Phytopathology in 1934 showing that Tabasco pepper plants responded to TMV infection with localized necrotic lesions, followed by abscission of the inoculated leaves. This dramatic outcome of a biological response to infection observed by Francis O. Holmes, a virologist at the Rockefeller Institute for Medical Research, was used to score plants for resistance to TMV infection. Our objective was to gain a better understanding of early to mid-twentieth century ideas of genetic resistance to viruses in crop plants. We investigated Holmes’ observation as a practical exercise in reworking an experiment, having been inspired by Pamela Smith’s innovative Making and Knowing Project. We had a great deal of difficulty replicating Holmes’ experiment, finding that biological materials and experimental customs change over time, in ways that ideas do not. Using complementary tools plus careful study and interpretation of the original text and figures, we were able to rework, yet only partially replicate, this experiment. Reading peer-reviewed manuscripts that cited Holmes’ 1934 report provided an additional level of insight into the interpretation and replication of this work in the decades that followed. From this, we touch on how experimental reworking can inform our strategies to address the reproducibility “crisis” in twenty-first century science. Phytopathology . Tabasco plants respond to TMV infection within a few days of inoculation, first with localized necrotic lesions (LNLs) on the inoculated leaf. The LNLs are mere pinpoints, oftentimes all but obscured by the damage incurred by rub-inoculation. Leaf abscission occurs a few days after LNLs are observed. This response—to sacrifice an inoculated leaf to rid itself of the virus—is a dramatic outcome. Francis O. Holmes, a virologist at the Rockefeller Institute for Medical Research, used both responses to monitor for the presence of a dominant gene for resistance to TMV infection.1If a photograph is worth a thousand words, then we were taken (in) by an image from a 1934 scientific manuscript in the journal We were interested in replicating this experiment as an exemplar of “practicing virology” within the context of the history of science. Our work, initially inspired by Pamela Smith’s Making and Knowing Project, was fraught with challenges. A seemingly simple experiment belied the complexity and challenges of reworking an experiment from the past. We concluded that some experiments from the past cannot be replicated in full; that complementary methods are oftentimes necessary to interpret experimental results across the decades; that careful and attentive reading and interpretation of text and figures is necessary and essential to rework an experiment; and, identification and reading manuscripts that cite the original work is an extremely useful tool to interpretate historical experiments. Here we discuss our challenges and successes with reference to findings from historians of science who have reworked interesting experiments of the past. We also touch on the role of craft (making) and pitfalls associated with biological materials for historical reworking (knowing). In relation to a perceived “reproducibility crisis” in recent science, we discuss, in light of our experience, potential difficulties in reworking experiments, which includes identifying, replicating, funding and publishing the results. Finally, we hope our experiments will encourage more hands-on reworking as a key component of the historiography of the life sciences because of its informative value.Prior to the rediscovery and wide-spread acceptance of Mendelian genetics, crop improvement was based on observation. Plant pathologists and breeders would survey fields, collecting seeds of plants with desirable traits, such as improved yield, or escape from the ravages of diseases. This seed would be increased and used in subsequent seasons. Another, more focused strategy, evaluated seed from local collections or that provided by the USDA.3Nicotiana glutinosa leaves. The virus was confined within the boundaries of the lesions on the inoculated leaf—this host response was protective, allowing the tobacco plant to complete its lifecycle without detriment. Holmes determined this response was due to N. glutinosa harboring a single dominant gene (N) for resistance to TMV infection  as a first step to develop commercial tobacco lines with field resistance to TMV , finding it more amenable to Mendelian breeding strategies.L, analogous to the N. glutinosa N-gene. With this knowledge, Holmes incorporated the Tabasco gene L into commercial lines of bell pepper, thus protecting the plants from systemic TMV infection.L-gene is found in TMV-resistant bell pepper cultivars. The 1934 publication is important to plant pathology because it was the first demonstration that a resistance gene from one species could be used to protect another species from the ravages of virus infection. As shown by Holmes, Tabasco pepper leaves abscised within days of TMV inoculation, a striking means to visualize a gene-in-action in the pre-molecular biology era.This process was fraught with difficulties in that it took Holmes three years to advance this project Holmes, , 2016. DThe manifest issues of technique, skill, tools, and temporal distance have been addressed by Pamela Smith’s pathbreaking “Making and Knowing Project” at Columbia University. Smith has commented on “how odd it is that historians whose object of study is historical materials and techniques … have generally not considered engagement with the materials of their historical topics as an essential part of their training and research” Smith, , p. 9. H7In his TEA set paper Harry Collins addressed the difficulty of replication across physical distance, even for those expert in their area of practice and craft Collins, .8 CollinHere, we provide an example of reproducing knowledge at a temporal distance, using a biological experiment. We encountered many of the same problems mentioned in the TEA set paper as we worked to reproduce an experiment from a written document. Collins indicated that “written sources … as the sole source of information” are inadequate and the ability to reproduce an experiment or build a piece of equipment or “reinvent it” indicates that the (naïve) group “knows as much” as the reporter Collins, , p. 176.Several scholars have been at the forefront in engaging in the “experimental history of science”  using maize kernels 1). Our oN. tabacum cv. Turk and N. benthamiana (commonly used for laboratory experiments), were cultivated from our laboratory seed stock.12We purchased Tabasco and Heirloom California Wonder (sweet bell pepper) seeds from W. Atlee Burpee & Co. Two TMV-susceptible tobacco lines, C. frutescens) it is not possible to definitively state that the plant is identical to Holmes’ Tabasco; almost certainly it is not the same.L-gene in peppers provides an effective form of resistance” to “all tested strains of TMV from tobacco and tomato” . For example, a genetic analysis of ten lines of California Wonder showed the plants could be grouped into 5 classes, based on genetic polymorphisms identified by PCR amplification with a series of primer sets to randomly sample the genome , using a mortar and pestle. The negative control experiment, or mock-inoculation utilizes healthy leaves. Two or three lower leaves of a plant are rubbed gently with the sap extract following dusting with an abrasive powder (carborundum or Celite) to slightly injury the leaf, allowing virus ingress  inoculation Holmes, , 1931  gene (TMV-GFP)  was maintained on hod Fig. . UnfortuFP) Fig. A. TMV-GFFP) Fig. .17 TMV-Gopportunities for better historical understanding” . Our first estimation of plant age was based on plant height and the approximate leaf size , are both considered straightforward “ubiquitous practice”  exposed to cooler growing temperatures may experience premature leaf abscission  practice” . The choices we and Holmes made were not trivial or insignificant. As discussed by Jordan and Lynch in their analysis of the standardized protocol for plasmid preps: “For practitioners at the bench, these distinctions [choices] do not easy resolve such issues as what to include or exclude from a procedure, what to do now, and what to do next”  interpretation is integral to science practice. For example, Staffan Müller-Wille and Giuditta Parolini inspected copies of Mendel’s pea breeding manuscript, finding that readers “actively engaged with the text” by “rehearsing calculations and by employing Mendel’s notation system”  plants maintained at 23ºC developed “local necrotic lesions on mature and nearly mature leaves … and these leaves eventually absciss”  affected our ability to make and learn from Holmes. This has ramifications for scientists and historians who decide to replicate key experiments in their field. As we show here, and as discussed by Jordan and Lynch for plasmid preps, success with a particular protocol belies the depth of required experience and expertise by the users. Our difficulty in recapitulating Holmes’ work was difficult and interesting, and we learned a few things:L-gene pepper plants or developing new commercial varieties.1. We became better readers and observers. As noted by Pamela Smith and others, we too stumbled on the processual research, providing us with the opportunity (and necessity) of studying processes rather than discrete events, to carefully read the materials and methods, and then assemble the needed reagents and tools. This extends into the need for carefully reading the protocols following failed attempts. In the early stages, the process of re-investigation seemed straightforward. Yet it quickly became evident that we were missing or unable to identify the materials used by Holmes. We interpreted what we expected to observe; that is, we anticipated ‘seeing’ the exact outcomes shown in Fig. 2. Side projects are projects. The TMV-pepper experiment was piggy-backed onto ‘normal’ experiments in our molecular virology laboratory. We do not often perform experiments unrelated to our primary research interests. “What is typical, rather, are extended series of experiments which communicate among each other with different intensity and constitute an experimental texture,” as noted by Hans-Jorg Rheinberger , may have strong feelings “over just what sorts of variations are tolerable, trivial, or significant”  is equivalent to discovery-based research. Which experiments will be tested for reproducibility? For a specific example, which of 200,000 COVID-19 manuscripts published the past 18 months should be replicated?Of papers subjected to replication, how one approaches an experiment is predicated on many parameters, including biased approaches and interpretations.In their exploration of allosteric regulation, Angela Creager and Jean-Paul Gaudillière focused on the role of local knowledge and the co-evolution of meaning and experiments within individual locations  “marveled at the length of time it took to acquire experiential knowledge”(Smith,


What happens when the outside world begins to affect the classroom? Is theclassroom supposed to be neutral, objective, and devoid of feelings? Or is it aspace where students and teacher meet for healing, understanding, and criticalthinking? From news reports of police brutality to highly publicized acts ofracial aggression, students are inundated with examples of intolerance, hatred,and racial inequality. Those committed to critical pedagogy and social justiceinvite, embrace, and use these events to enhance classroom materials. Whathappens, however, when pedagogy is painful for both the student and the teacher?Several articles address the teacher’s experience and others the studentexperience. This article is dedicated to synthesizing and discussing bothexperiences from one course, Race and Ethnicity, at a height of racial tensionsin the United States and on campus and providing the personal and pedagogicalstrategies that developed from the course. They tell me that I am supposed to be teaching students to be objective, tobe neutral, and to rely on data to tell the story of inequality. What happens, however,when pedagogy is painful—when it literally hurts to teach and be taught? How should aprofessor balance between the emotional experiences generated from the real-world eventsoutside of the classroom with the learning objectives of the classroom?As a Latina who identifies as a Muxerista,I wrestled with this question particularly after teaching the course Race and Ethnicity(R&E) at Emory University, a historically white institution (HWI) situated in theSouth during the fall of 2015. What is the responsibility of the scholar who advancessocial justice and teaches with the goal of inspiring growth and change? According toChristina, a black womanJennifer, a first-generation Korean American womanJonathan, a queer, Latinx manJamesetta, a Liberian American woman and child of GodRocco, a gay, white manTo answer this question, I invited a diverse group of former students to provideperspectives, and ultimately, lessons, generated from their individual experiences in myR&E course. There were 38 students in the course that semester. When consideringpotential coauthors, I looked for social characteristics that reflected the diversity inthe classroom and the university. I also made sure to ask students that I would notteach again or who had graduated to reduce the imbalance of power between teacher andstudent. In the end, I invited seven students to contribute to the article and fiveresponded by submitting their portion. They described themselves in the followingmanner: I asked them to introduce themselves, explain why they took the course, discuss theirexperience in the course, discuss what they wish had been included in the course, andexplain what they need from professors when the subject matter ischallenging/painful.This conversation is framed in four parts. First, I summarize the literature related topedagogical practices deemed radical or rooted in social justice particularly aroundissues of race. I was searching for, but did not find, articles that would discuss howto address the personal and painful experiences of both student and teacher. Second, Iset the historical and social context of the “tumultuous times” that occurred on campusand across the United States. In doing so, I use the students’ own words to describetheir personal experiences as well as the emotional pain they felt on campus and inclass during a particularly stressful time period. In addition to directly quoting thestudents, I use their words to describe the campus, classroom, and their experiences.Third, I describe my own personal and emotional experience of the course as a Chicanagraduate student. Fourth, I synthesize the student’s suggestions in an effort tocontribute to an ongoing conversation about how to reduce the effects of painfulpedagogy. Finally, in sharing my own lessons, I discuss strategies for how instructorscan connect the emotional, pedagogical, and political experiences to the scholarlyresearch. This article is a collaboration between student and teacher written with thegoal of sharing experiences that prompt discussion on the role of emotions and personalexperiences in a the classroom of professors committed to social justice.My questions regarding painful pedagogy emerged when I tried to find guidance aboutdealing with emotional experiences in the classroom. What I discovered was a mixtureof various scholarly discussions related to teaching challenging and/orcontroversial courses that can create conflict, particularly as it relates to race,but no articles that discussed fear, rage, sadness, heartbreak, and other potentemotions. There are also plenty of articles about how faculty and student experiencerace in the classrooms separately but a dearth of articles that discuss bothexperiences simultaneously. This conversation, we hope, prompts a deeper explorationof whether or how to manage, discuss, and perhaps even incorporate emotions of bothprofessor and student in the classroom.emotions required to deploy those forms of pedagogy. Theliterature, I found, is largely framed around the ideas that such courses presentchallenges, controversy, and/or conflicts.Much of the literature that considers personal experiences is deeply rooted inprinciples of social justice. Teaching styles rooted in social justice had severaldescriptors, including but not limited to “[making] the personal political,”“scholar activism,” “radical pedagogy,” “critical pedagogy,” and “education by thecurrent event” . When Swsic] atmosphere that reflects not only our [the UnitedStates’] contentious history on matters of race but also several cross-cuttingcurrents that characterize this particular historical moment.” Experiences ofoppression, racism, and discrimination are not simply relics of the past but verymuch the lived experience of the students. These current events often elicit strongemotional responses. While they offer valuable insight in how institutions canmanage and support controversial topics, their workshop involved teachers but nostudents. By no means am I suggesting that the absence of student input makes theirsuggestions invalid. I am, however, identifying a gap in the literature. Professorsand departments are accustomed to reaching “up and across” to fellow colleagues butnot necessarily “down and back” to students who are often the recipients of coursematerials and participants in discussion that are inherently controversial.The literature seems to talk around emotions or describes emotional experiences, butvery few articles treat it as a central theme or question. For example, Throughout the years, teachers and professors have offered several suggestions forhow to overcome a variety of challenges presented in a controversial classroom. Chaissoagony as their descriptor. They do not, however, provideguidance on how professors should manage or recognize that agony. They also do notdiscuss what to do when the professor feels that agony as well. As for whitestudents, much of the literature reveals that the benefits of diversity only comesif and when white students actively engage with students from diverse backgroundsand participate in dialogues with diverse student populations . It was not just theUniversity of Missouri. It was Yale, Duke, Columbia; those cries also poured out ofthe campus of Emory University. The Black Students of Emory (BSE) movement tookroot, and a number of students from the course were involved in its organizing.While I was lecturing about historical and contemporary racial injustice, studentswere confronting it on campus and generating a list of demands . The polThe students, without prompting, described how they felt around campus that semester.From depression and hopelessness to anger and frustration, my coauthors describednumerous negative and even violent emotions. Jonathan explained that his “brown,queer body” was a “site of colonization . . . a site of trauma, a site of dailyviolence.” Referring to issues of police brutality, segregation, and deportation, aswell as antiblack and anti-immigrant rhetoric, he wrote, “The migraines became moreconsistent. The depression came in longer episodes.” Other students reported mentaland emotional assaults in the form of a social media application (app) called YikYak, where students could post comments anonymously. The comments posted to this appwere littered with verbally abusive and racist remarks. One student shared with methat as he walked around campus he looked at white students and wondered, “Did youwrite that? Do you feel that way?” This, if anything, was a clear example of what W.E. B. Du Bois identified as double consciousness: experiencing the world through twosets of eyes simultaneously.racism outbreak”emerged that she could not escape. She described walking around campus experiencingmicroaggressions, prejudice, and racism from students and teachers only to return toher home and witness people dying and suffering all around the world, in schools,and in the streets.Jamesetta used the phrase “extremely overwhelming” to describe her feelings on campusthat semester, saying that it felt as if “a huge I asked the students to write about why they took the course and to describe theirexperience of it. Their responses also contained a range of emotions, but mostdescribe immense pain and overwhelming sadness. Jamesetta explains that taking thiscourse during such a trying time for the black community was “devastating.” Sherecounted that going to class felt like reliving her own ancestral struggle as wellas the struggles of her “Latino American, Native American, Asian American brotherand sisters.” She described the classroom as “therapeutic but also mentally andemotionally exhausting.”Christina shared a similar experience. She wrote about the seemingly unending processof having “the race talk” in class, on social media, and in her home. When watchingthe news, reading books, engaging in academic discourse, and performing her dailyactivities, she was reminded that “the odds are stacked against black women.” Shewas reminded that the “American Dream” might never be her reality. She describedthis process as painful, stressful, and discouraging. She, along with her friends,would wonder if their $200,000 education was worth making only 68 cents to thedollar of a white man. She confessed that she wondered, was it worth it for studentsof color to try and better themselves if they are only “going to be looked at asinferior on the grand scheme of things?”Jennifer explained that while she was eager to “learn the language of race scholars,”learning about the history of contemporary racism experienced by Asian AmericanPacific Islanders (AAPIs) did not make her “feel any better.” She found that despitebeing labeled a “model minority,” she and members of her community still experience“hellish ridicule and belittlement” but have learned to “take pain and mask it withself-satisfaction.”Jamesetta further described the pain of learning about racism at an intellectuallevel while also experiencing personal realizations. “It hurt to realize theprevalence and deep-rooted anti-blackness in modern culture,” she wrote. “It hurt tosee the evidence of anti-blackness in everyday mundane things.” While Jamesettawitnessed anti-blackness, Jennifer and Rocco were confronting it within their owncommunities.Jennifer explained that it was “absolutely debilitating” to realize how herexperiences fit into the race narrative and racial hierarchy. She vividly describedhow her mother would put sunscreen on her face to avoid being “black as chocolate”while she looked in the mirror longing to be whiter skinned. Describing her AAPIcommunity as both victims and perpetrators, she longed for reconciliation to relieve“the guilt that weighs down hard” for her own complicity in believing, at one time,that black and Latinx students were illegitimate and less skilled. However, she alsorecognized that the oppression her community experiences, while different, is noless important to consider. She shared, “Police don’t take [Asians] seriouslybecause they don’t understand our accents and politicians consider [Asians] passiveconstituents whose loyalty belongs to the ‘motherland’ despite being full Americancitizens.”Rocco acknowledged that he lived much of his life sheltered in a very wealthy andwhite part of Orlando, Florida. Even though he joined the course to understand theexperiences of others, he struggled to understand his role and responsibility aswhite, gay male with privilege. While he noticed racism in the gay community, he wasalso wary of the homophobia within certain racial communities. As he began noticingracism in every aspect of his life, he wrote, “It angered me and inspired me toexplore questions regarding the root of the problem.”Ultimately, it was Jonathan’s description that was the most heartbreaking to read.“Without a doubt,” he wrote, “the course was, at times, a dagger that kept stabbingan open wound.” I knew my students were hurting, but I did not recognize that mycourse was a source of their pain. In the next section, I describe my own parallelexperience teaching the course.passionate. Wearing my heart on mysleeve, however, also means that anyone can tell when I am angry, frustrated, orsad. I try, but fail miserably, to “fix my face.” I am, in a word, emotional. I amalso very personal. I share stories of family, partner, and child so regularly thatmy students inevitably ask to meet them. While I struggle with whether or not thesecharacteristics are stereotypically associated with women and Latina professors, Iam beginning to embrace these qualities as strengths rather than liabilities.Family, friends, and colleagues tell me that I wear my heart on my sleeve. I loveteaching and have been told that, too, is obvious. In my student evaluations, theword that comes up most often is The fall of 2015 marked the first time my class would be opened to 40 students. Itwas the second time I taught the course by myself. When I teach my R&E course, Istructure it in the following manner: First, I establish the theoretical foundationson which the course is built discussing critical race theory, racialization, racialformation, the myth of color blindness, intersectionality, and feminist theory.Next, I focus on the sociological, legal, and historical construction of race acrosseach of the different racial groups as well as whites and multiracial Americans.Afterward, I introduce contemporary racial inequalities as they are related toeducation; crime; lesbian, gay, bisexual, transgender, and queer/questioning plus(LGBTQ+) communities; racial identity politics; and mental health. Each week, Iworked diligently to be as inclusive as possible by providing literature on all thedifferent racial and ethnic groups written by a diverse pool of authors. I loveteaching this course, and this semester was no different.However, several events occurred over the summer and into the fall of 2015 that madeits way into the classroom. First, there was the brutal death of Freddie Gray in theback of a police truck as well as the suspicious death of Sandra Bland byasphyxiation. Over the summer, the Black Lives Matter movement was growing inmagnitude, becoming more organized, and inspiring students to activism. Also inNovember, a Cook County judge ruled that the dash cam video of 17-year-old LaquanMcDonald being shot 16 times by a Chicago police officer should be released to thepublic. The video was gruesome, heartbreaking, and maddening. Almost simultaneously,students at the University of Missouri, in response to racial incidents on campus,began demanding that the administration confront the racism on campus, providereparations in the form of free tuition, and divest from for-profit prisoncompanies.It was during this time that I felt a palpable shift in the energy of the classroom.Some of my students who were very engaged in the course stopped attending class.Other students would visit my office and report feeling stressed, frustrated, andlonely. Others would say things like, “Every time I leave this class, I leave morehopeless than when I came in.” I grew concerned that the course materials werecontributing to their sense of hopelessness. During that particular time, they readarticles about mass incarceration, lynching in the West, racial profiling, thedeaths of Native Americans at the hands of police, and studies debunking theconnections between immigration and crime that Trump attempted to make with his“criminals and rapists” comment over the summer.At one point, I shared with my partner that I lost my students and had no idea how toget them back. All I knew to do was to stay the course and continue teaching thesyllabus I had organized. I felt like the course materials wounded my students,especially the ones who were at one time excited about the course. I triedcontacting them with no success and hated knowing that they would likely earn a D inmy course.That particular semester, I remember feeling isolated because the members of thebeloved community that I had developed in graduate school were in the last year oftheir program writing their dissertations or had moved away to another city. When Ishared my concerns, a faculty member simply told me that I should not allow theevents of the semester to change my standards. The students who do not do the workshould not be given special consideration especially when there are students who arediligently completing the assignments. I was not their therapist or friend. I wastheir professor.I did not know how to explain that I, too, was hurting because they were hurting. Ifelt as if I could not express that I, too, felt anger, sadness, and hopelessness atthe tragic, needless, and unpunished deaths of black men, women, and children at thehands of the police. I could not say that as Trump’s anti-immigrant rhetoricincreased, I experienced moments where people would initiate intense conversationswith me about why “my people” could not follow the law and would openly tell me thatthe government needs to send “you people” back to Mexico. I was also given, onnumerous occasions, the backhanded compliment and assurance that Trump was nottalking about me because I was not like “those people.” It felt as if they hadalways just stopped short of calling me a “good Mexican.”As students at the University of Missouri voiced their concerns of racism on campus,my students began to speak openly about the additional pressures, which is supportedby the literature, that they felt on campus and in the classroom as first-generationstudents and students of color . In addiThis seemed to help the students. Jamesetta shared that as an advocate for socialjustice, she decided to participate in a locally organized march that ended in themiddle of the intersection of a major roadway in front of the university and blockedtraffic. “It was risky,” she explains, “but it was necessary to show the world thatenough was enough and that the black students at Emory would no longer be silent.”Rocco shared how recognizing institutional racism encouraged him to become involvedin social movements and teach-ins on campus associated with Black Lives Matter andthe Dakota Access Pipeline. He confessed that he used the course materials to“fact-check” family members and friends who made racist or insensitive remarks.From participating in a march to correcting a family member, many students do notrecognize their actions as an example of the sociological imagination we try so hardto get them to understand. Asking students to connect what happens outside theclassroom to what they are learning inside the classroom is exactly the kind ofcritical thinking and analysis we push them to develop.Still, I could not shake the feeling that I was missing the mark. I was not givingthe students what they needed. It was this feeling that prompted me to include thequestions of what they wish I had done differently and what they need fromprofessors who teach challenging courses. Their requests and suggestions are listedin the next section, and my response is in the succeeding section.Jamesetta shared that I did not include enough materials on the diversity withinAfrican American communities in the United States. As a child of twomiddle-class, immigrant parents from Liberia, she represented the“diasporization” of African immigrants who came to the United States as studentsand/or resourced individuals . Hermuland disparate ways.Black communities, she explained, reflect as much diversity as Latinx and AsianAmerican communities. They, too, represent different countries, languages,customs, traditions, histories, and experiences. They, too, are wealthy, middleclass, successful, and accomplished, and complicate the U.S. racial narrative.These stories, she explained, are not recognized in society and were notreflected in my syllabus. Instead, she learned about the historical roots ofracial inequality and their contemporary effects for those individuals whoseentire experience is based in the United States. People experience theirblackness in similar When a POC occupies the role of professor, the responsibilities and implicationsare clear. This professor, for example, may be the only POC students haveencountered in their entire academic career. Christina and Jennifer both sharedthat, prior to this course, they had never in their entire educationalexperience had a teacher or professor of color or been taught by fellow memberof the AAPI community, respectively. Christina shared that when she was a younggirl, she compartmentalized careers by race. She always assumed her educationwould come from someone who did not look like her. Jonathan explained thattaking the course was a “survival tactic” for him to manage life at an HWI andthat having a POC teaching the course was empowering and helped him to have avision of becoming an educator as well. “Students of color,” he contends, “needan ally to let them know that they are not alone and to help [students of color]stay grounded.”Just as there are unique, unwritten responsibilities for professors of color whoteach an R&E course, there are also, according to my coauthors, some veryimportant things a white professor needs to consider. Christiana A., forexample, provides an important example of the dangers of not recognizing and/oracknowledging one’s own privilege. She describes an instance when a whiteprofessor told a Nigerian student that her personal experience did not makesense because of what he had studied about Yoruba culture. She wrote, “This wasfrustrating and annoying, and an ineffective way of creating dialogue. Instead,the professor could have affirmed the student’s experience and presented what heknew about Yoruba culture to open a dialogue about a potential explanation forthe discrepancy.” When professors acknowledge or are aware of their ownprivilege, the students explained, it demonstrates humility and promotes healthyand helpful conversation.Jamesetta affirmed my concern that the course materials were deeply embedded in adeficit model, where POCs embody all the deficits while whites set thestandards. She wrote, “After discussing the course with fellow students, werealized that there is a need for courses that teach about the painful past butalso celebrates the contributions and successes” of POCs. Professors who teachrace, she contends, need to “brighten up” the material with some triumph andsuccess, thereby making the subject matter easier to swallow. She longed formaterials that would highlight the resilience of marginalized communities sothat being a POC “does not feel like a tragedy when studying history.”The “white-is-right” narrative dominates our discussions regarding inequality.Whites make more money, own bigger houses, have access to better education, andbenefit in ways we are just beginning to measure. Whiteness, however, is notalways the ideal. Whiteness is not always the measuring stick that POCs use tomeasure success. Rocco shared that he and other white students in the coursewere surprised to hear that, among communities of color, whites were sometimesconsidered dirty, promiscuous, lazy, academically mediocre, too focused onsports, and classless . These r[In class] we discussed how other minorities have had similar battles inthe world. Instead of just focusing on the Black community, we need torecognize the brothers and sisters that we need to fight alongside.Their stories are not really heard.All of the students reported that moving racial discourse beyond the black/whitebinary was appreciated. Jamesetta wrote, Christina echoed the sentiment, explaining that she “wanted to learn about howall cultures work together . . . not just black and white.” Jonathan shared thattaking the time and care into making sure the content of the course is inclusiveand relevant “makes a difference.”Beauty and the Beast, which featured a gay character with avery small role, he experienced a strong emotional response. “After leaving thetheater,” he wrote, “I cried in my car imagining how impactful it would havebeen to see a gay character when I was a child. I was overcome with emotionthinking about how all the confused little boys and girls would be comforted bythis representation.” He shared that positive portrayals of characters fromdiverse populations can be an enormous tool in educating adults and childrenfrom all walks of life.Rocco explained that by watching documentaries that discussed the portrayal ofminorities, he learned how deeply it could impact how people view those groupsbut also how they see themselves. Recently, after viewing the Disney remake ofAll of the students’ requests and suggestions challenged me to sit back and determinehow I could incorporate their requests in the next iteration of my syllabus. Theirsuggestions left me both inspired and affirmed. I realized that some of my studentsfelt left out of my syllabus, comforted by and concerned about me as a teacher,frustrated yet inspired to act, and eager to learn more about others. For many of mycolleagues who teach R&E courses, much of this may seem obvious. However, as agraduate student who was developing her own expertise and learning scholarly norms,it was not always obvious to me. After much reflection, the following are some ofthe pedagogical changes I will make and also some strategies for managing my ownemotions.every experience, I can, at thevery least, include more articles on the experiences of the children of Africanand Caribbean immigrants. The narrative and social history of African Americansin the United States is not their story. Like Afro-Latinx individuals, theyoccupy a position where race and ethnicity collide. They are raced as black inAmerica, but everything about their homes, their language, their food, and theirlife is Nigerian, Ghanaian, Haitian, or Guyanese, to name a few. Thoseexperiences cannot and should not be erased in the racialization process.While I realize I cannot capture 2 I have readnumerous essays that contain the sentence, “I didn’t know I was black until Icame to the states.” In addition to being supported by the literature, thisdisconnect has been the subject of intense debate within black communities.Henry Louis Gates and Lani Guinier, for example, debated how the admissions ofAfrican and Caribbean students have become a substitute for accepting AfricanAmerican students , Native American plaintiffs(Piper v. Big Pine and McMillan v. SchoolCommittee), and Mexican American plaintiffs . Expanding thediscussion to include Asian American, Indigenous, and Latinx experiences notonly encourages students to recognize that activism is not just black/white butalso allows me to have a more theoretically informed discussion about the U.S.racial hierarchy via Asian critical race theory, tribal critical race theory,and Latinx critical race theory  between the experiencesof POCs. I am, however, using the mathematical symbol for simile (≈) todemonstrate how oppression works across and through groups in very similar, yetcomplicated, ways. For example, when I teach about school desegregation efforts,I discuss not only e theory .In his review on the sociology of emotions, en lafamilia,4 sitting with someone and telling her my deepest, darkestfeelings and thoughts felt like a transgression and betrayal at first. Therapy,I had been taught, was for weak, white women. I, on the other hand, had comefrom a long line of strong women who overcame enormous odds andpersonal tragedies to provide me with the opportunities I now enjoy. In thegrand scheme of things, my feelings were nothing compared to the poverty,punishment, and pain my family endured.According to the groundbreaking and subsequent work of before I scheduled an appointment in order to find my ownpersonal brave space.Needless to say, it was a big step for me to sift through therapists who found me“fascinating” where I became their personal race-and-culture expert instead of aclient. I realized it was okay to ask for their experience with women of colorThis is by no means an exhaustive list of recommendations and is not a substitute forconducting rigorous studies on student learning and/or suggestions for such courses.There is also no one “best” strategy for managing emotions in the classroom. Thisconversation represents the reflections of students and their professor after aparticularly painful semester. I am sure these students completed a courseevaluation indicating on a Likert scale whether or not “the instructor explainedspecific concepts relevant to the course.” However, asking these five students towrite about their personal and emotional experience of the course challenged me toparlay their suggestions into the transformative pedagogy that criticalconsciousness demands. Students need to see their experiences reflected in thesyllabus and in the course materials to educate and inspire them and fuel theirdesire for social change.With the divisive 2016 presidential election, there does not appear to be an end orreprieve from tumultuous times that sometimes drip and oftentimes flood into ourclassrooms. This administration provides plenty of material to analyze during acourse on race, ethnicity, and immigration. Frankly, it provides plenty of materialfor any sociology course. Acknowledging the emotional toll such discord may have onself and student is a valuable process in which to engage. Furthermore, engagingformer students in a postcourse discussion is another opportunity to identify one’sown blind spots, particularly in an area of expertise. In closing, thiscollaboration helped me to realize that, while I cannot control painful situations,I can work to transform personal pain into meaningful pedagogy.