Territories of scarcity and creativity: a critical view of informal settlements and emerging tactics under conditions of scarcity in Nairobi, Kenya and Quito, Ecuador

This thesis explores the processes through which scarcity is constructed in informal settlements and how conditions emerging within its limits gives way to particular socio-spatial phenomena and influence the emergence of self-organisation and creative strategies from a non-expert perspective. At the same time, this thesis deconstructs these emerging tactics (reactive and transformative) in a diagrammatic way to generate a critical study of their potential for socio-spatial change that goes beyond the everyday survival. Most people associate scarcity with “not having enough” of something, most usually of a material nature. In contrast, this paper is based on the premise that scarcity is a constructed condition, therefore exploring it beyond its immediate manifestation and illustrating its discursive, distributive and socio-material components. In this line, the research uses Assemblage Theory as both an approach and a tool for analysis. This approach allows the research to depart from everyday narratives of the residents, and gradually evolve into a multi-scalar, non-linear reading of scarcity, by following leads into different realms and unpacking a series of routine events to uncover their connections to wider processes and particular elements affecting the settlement and the city as a whole. For this purpose, the research is based on a qualitative, flexible and multi-sited methodology, using different case studies as testing grounds. Collected data stems from a 11-months ethnographic fieldwork in informal settlements in Ecuador and Kenya, analysing the socio-spatial practices and strategies deployed by the different actors producing the built environment and arising from everyday and latent experiences of scarcity. The thesis examines the multi-scalar nature of these strategies, including self-building and management tactics, the mobilisation of grassroots organisations, the innovative ways of collaborating deployed by different coalitions and the reformulation of urban development policies. As outcomes of the research, the thesis will show illustrative diagrams that allow a better understanding of, firstly, the construction of scarcity in the built environment beyond its immediate manifestation and secondly, the way that emerging tactics a) improve existing conditions of scarcity, b) reinforce the status quo or c) contribute to the worsening of the original condition. Therefore, this thesis aims to offer lessons with both practical and theoretical considerations, by firstly, giving an insight into the complexity and transcalar nature of the construction of scarcity in informal settlements; secondly, by illustrating how acute conditions related to scarcity gives birth to a plethora of particular phenomena shaping the territory, social relationships and processes; and thirdly, by identifying specific characteristics within the informal that might allow for new readings of the city and possibilities for socio-spatial change under conditions of scarcity.

Using a whole person approach to support people with cancer: a longitudinal, mixed methods service evaluation

Introduction: Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this paper is to (1) evaluate short and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC); (2) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods: Longitudinal mixed-methods service evaluation (n=135). Data collected included health related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity - MYCaW); lifestyle behaviour (bespoke questionnaire) and participants’ experiences over 12 months post course. Results: Statistically and clinically significant improvements from baseline - 12 months in severity of MYCaW Concerns (n=64; p<0.000) and mean total HRQoL (n=66; p<0.000). The majority of MYCaW concerns were ‘psychological and emotional’ and about participants’ wellbeing. Spiritual, emotional and functional wellbeing contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. 3-6 months post-course was identified as the time when more support was most likely to be needed. Conclusions: Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behaviour change were also identified. These data then informed wider and more person-centred clinical provision to increase the maintenance of positive long-term behaviour changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed.