Even If You Know the Theory: Informality, Innovation, and Flexibility in Ethiopian Biomedical Practices

• In Event: 471 - Section on Medical Sociology Paper Session. Global and Transnational Health

Abstract

This paper explores the interconnectedness of informality and flexibility, both hallmarks of neoliberalism, within medical practices and professional conflicts among physicians in two rural Ethiopian hospitals. Biomedical culture in these hospitals is produced through tensions between technologies and standards within idealized academic medical centers and the realities of practice in this setting, constrained by lack of resources, unpredictable staffing and programs, and limited opportunities for training and research. Current U.S.-centric, but often irrelevant, “best practices” are shared between Ethiopian physicians through digital versions of American textbooks and databases, leaving clinicians struggling to negotiate the evidence-based yet applicable and patient-centered care that defines “good” medicine. Physicians resort to informal networks and practices, improvising in diagnostics and procedures and establishing connections to sources of resources and education outside of official channels. These attempts to resolve professional conflicts, redistribute social goods, and preserve biomedicine as an intellectually satisfying and humane endeavor are largely dependent on transnational networks of medical personnel, equipment, and ideas. Informal resources are often connected to short-term medical volunteers, whose flexibility allows them to cross and reconstruct boundaries within this unsettled space. Relying on hospital ethnography and interviews in a rural community, I demonstrate that the friction-laden coproduction of informality and flexibility is evident within these locally contextualized clinical practices and discourses. The inherent conflicts between globalized standards, unpredictable transnational medical networks, and innovative practices produce local medical economies, unique forms of politicized patients, and improvised clinical spaces and practices reliant on a mosaic of techniques, explanations, and assumptions.

Author

• Stephanie Rieder, University of Illinois at Urbana-Champaign