Negotiating “The Social” and Managing Tuberculosis in Georgia
- 272 Downloads
In this paper I utilize anthropological insights to illuminate how health professionals and patients navigate and negotiate what for them is social about tuberculosis in order to improve treatment outcomes and support patients as human beings. I draw on ethnographic research about the implementation of the DOTS (Directly Observed Therapy, Short Course) approach in Georgia’s National Tuberculosis Program in the wake of the Soviet healthcare system. Georgia is a particularly unique context for exploring these issues given the country’s rich history of medical professionalism and the insistence that the practice of medicine is a moral commitment to society. I argue for critical attention to the ways in which treatment recipients and providers navigate what, for them, is “social” about therapeutic practices and their significance for avoiding biological and social reductionism.
KeywordsTuberculosis Global health Social disease Georgia
I extend my deepest thanks to everyone at the NTP and MSCI in Tbilisi who helped me with my research. The project was supported by a Dissertation Improvement Grant from the Science and Technology Studies Program of the National Science Foundation; the Eurasia Program of the Social Science Research Council, with funds provided by the U.S. Department of State through the Title VIII Program; the Graduate Faculty of Political and Social Science at the New School for Social Research; and the University of Kentucky. Portions of this article, including ethnographic examples and theoretical analyses, have appeared in previous texts written by the author and published in the journals American Ethnologist and Medical Anthropology: Cross-Cultural Studies in Health and Illness and in the book Free Market Tuberculosis: Managing Epidemics in Post-Soviet Georgia (2013, Vanderbilt University Press). I am responsible for any errors.
- Abdullaev, N. 2000. Tuberculosis rages in the Caucasus. Prism 6(10). http://www.jamestown.org/single/?tx_ttnews%5Btt_news%5D=27962&no_cache=1#.VnglWYT8-_s. Accessed June 19, 2003.
- Cohen, L. 2000. No aging in India: Alzheimer’s, the bad family, and other modern things. Berkeley: University of California Press.Google Scholar
- Dubos, R., and J. Dubos. 1992. The white plague: Tuberculosis, man and society. New Brunswick, NJ: Rutgers University Press.Google Scholar
- Ecks, S., and I. Harper. 2013. Public–private mixes: The market for antituberculosis drugs in India. In When people come first: Critical studies in global health, edited by J. Biehl and A. Petryna, 252–275. Princeton: Princeton University Press.Google Scholar
- Farmer, P.E. 1999. Infections and inequalities: The modern plagues. Berkeley: University of California Press.Google Scholar
- Farmer, P.E. 2003. Pathologies of power: Health, human rights, and the new war on the poor. Berkeley: University of California Press.Google Scholar
- Gelmanova, I.Y.D.V., S.P. Taran, A.A. Mishustin, A.V. Solovyova Golubkov, and S. Keshavjee. 2011. “Sputnik”: A programmatic approach to improve tuberculosis treatment adherence and outcome among defaulters. International Journal of Tuberculosis and Lung Disease 15(10): 1373–1379.CrossRefPubMedGoogle Scholar
- Harper, I. 2006. Anthropology, DOTS, and understanding tuberculosis control in Nepal. Journal of Biosocial Science 38(1): 56–67.Google Scholar
- Harper, I. 2014. Development and public health in the Himalaya. London: Routledge.Google Scholar
- Kleinman, A., V. Das, and M.M. Lock (eds.). 1997. Social suffering. Berkeley: University of California Press.Google Scholar
- Koch, E. 2013. Free market tuberculosis: Managing epidemics in post-Soviet Georgia. Nashville: Vanderbilt University Press.Google Scholar
- Koch, E. 2015. Protracted displacement in Georgia: Structural vulnerability and “existing not living.” Human Organization 74(2): 135–143.Google Scholar
- Latour, B. 2007. Reassembling the social: An introduction to actor-network-theory. Oxford, UK: Oxford University Press.Google Scholar
- Lessem, E. 2014. Tuberculosis drug development hobbles forward. In 2014 pipeline report, edited by A. Benzacar, 19–21. New York: i-Base/Treatment Action Group.Google Scholar
- Lindenbaum, S. 1978. Kuru sorcery: Disease and danger in the New Guinea Highlands. Mountain View, CA: Mayfield Publishing Company.Google Scholar
- Lock, M. 1993. Encounters with aging: Mythologies of menopause in Japan and North America. Berkeley: University of California Press.Google Scholar
- Martin, E. 1987. The woman in the body: A cultural analysis of reproduction. Boston: Beacon Press.Google Scholar
- Moshin, A. 2014. Treating tuberculosis as a social disease. The Lancet 383(9936): 2125.Google Scholar
- Packard, R.M. 1989. White plague, black labor: Tuberculosis and the political economy of health and disease in South Africa. Berkeley: University of California Press.Google Scholar
- Peuch, J. 2002 Georgia: Official says TB epidemics contained, but warns against too much optimism. Radio Free Europe/Radio Liberty (RFE/RL), October 29. http://www.rferl.org/content/article/1101224.html. Accessed March 13, 2005.
- Porter, J., K. Lee, and J. Ogden. 2002. The globalization of DOTS: Tuberculosis as a global emergency. In Health policy in a globalizing world, edited by K. Lee, K. Buse, and S. Fustukian, 181–194. Cambridge, UK: Cambridge University Press.Google Scholar
- Seeberg, J. 2013. The death of Shankar: Tuberculosis and social exclusion in a poor neighbourhood in Bhubaneswar, Odisha. In Navigating social exclusion and inclusion in contemporary India and beyond, edited by K.B. Nielsen, M. Fibger Qvortrup, and U. Sudoka, 207–226. London: Anthem.Google Scholar
- Virchow, R. 1958. Disease, life, and man. Translated by I.J. Rather. Stanford, CA: Stanford University Press.Google Scholar
- World Health Organization. 2015. Global tuberculosis report. Geneva: World Health Organization. http://apps.who.int/iris/bitstream/10665/191102/1/9789241565059_eng.pdf?ua=1. Accessed November 30, 2015.