title: The unfortunate generation: stroke survivors in Riga, Latvia.
abstract: The poor health status of citizens in post-Soviet states has been reported but few studies have investigated the illness experiences of people in those countries. This paper reports findings from an interview study conducted with stroke patients in Riga, Latvia, who were part of a cohort recruited over 1 year for a European study comparing the provision of care, outcomes and resource use. The interview study aimed to elicit stroke patients' own perceptions of the impact of stroke 1 year after the event. Adopting a phenomenological perspective we illustrate how the particular social setting shapes stroke as an illness, its influences on access to health care and on consideration of the impact of stroke. We argue that for stroke survivors and their relatives in post-Soviet Latvia this disorder acquires a meaning that transcends the individual biography and signifies an upheaval of social life in general. The meanings attributed to stroke by interviewees are developed in the context of the momentous recent historical events which participants lived through. In this sense, stroke has become an idiom of a disruption in social biography rather than individual biography alone. Most participants were pensioners and their main concern was their own poverty. Some complained of their inability to meet their basic needs, much less pay for on-going medication and therapy. Only one person was 'severely disabled', using a standard neurological definition, but about half of those interviewed regarded the stroke as a sign foretelling their own death. Although this generation had expected to be cared for in their older age under the Soviet regime, the much longed for Latvian independence was seen to have brought unexpected hardships for those who were old and sick.
authors.affiliation: Department of Public Health Sciences, King's College London, Capital House, 42 Weston Street, SE1 3QD, London, UK. christopher.mckevitt@kcl.ac.uk <christopher.mckevitt@kcl.ac.uk>
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
authors.forename: Agita
authors.initials: A
authors.lastname: Luse
authors.forename: Charles
authors.initials: C
authors.lastname: Wolfe
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D007844:Latvia / Q000453:epidemiology; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D018434:Sickness Impact Profile; D012922:Social Change; D012944:Social Support; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000523:psychology*; D000071939:Stroke Rehabilitation; D017741:Survivors / Q000523:psychology*