Dissertation Research: Microbes, Markets and Medicines: Confronting Tuberculosis in post-Soviet Georgia

本论文项目调查了苏联格鲁吉亚结核病(TB)科学和医学知识生产中的制度和技术变化。它审查了社会和政治不稳定对医疗改革的影响，以及医疗从业者在科学和医疗环境下的国家重建进程中的经验。与前苏联大部分地区一样，格鲁吉亚目前正面临广泛流行的结核病和耐多药结核病(MDR-TB)。整个FSU的巨大社会和经济变化导致了极高的贫困水平、拥挤的生活条件以及食物和能源短缺，所有这些都造成了结核病在世界许多地区成为地方病的条件。随着苏联的解体，中央集权的医疗基础设施也随之瓦解。有效治疗和控制结核病所需的技术资源严重短缺，支付医疗从业者工资、获得基本诊断和治疗用品以及以其他方式维持稳定的生物医学研究和治疗设施所需的财政资源严重短缺，这给当地医疗保健系统带来了巨大困难。在多年的种族冲突之后，格鲁吉亚正处于严重的能源危机和持续不断的政治和经济动荡之中。文化、政治和经济条件助长了结核病的传播，并使总体上的医疗改革，特别是根除结核病变得更加复杂。这场健康危机引起了世界卫生组织(WHO)和国际卫生界其他成员以及其他西欧和美国人道主义援助机构如索罗斯和美国国际开发署的高度关注。它们正在努力与当地和国际的各种公共和私营援助组织、医院、实验室、制药公司和政府组织协调努力，以实施基于世卫组织的管理和治疗战略的标准化。通过在这个由实验室、诊所和行政站点组成的网络中使用参与观察、访谈和文件分析的人种学方法，研究人员将追求三个主要目标。具体地说：1)绘制格鲁吉亚结核病知识生产中不断变化的行动者星图以及他们旅行和互动的跨国路线和关系；2)了解“西方”科学和医学论述、技术和做法在格鲁吉亚具有地方意义的过程；3)从而从一般保健改革的角度了解权力下放和国家重建的更大进程，特别是改变结核病管理和控制战略的体制和技术方面的进程。这项研究将有助于理解这些过程，并有助于生物医学机构和资源的组织和分配与当地和全球的文化、政治和经济力量密不可分。作为有关传染病的生物医学知识产生的一种文化方法，该项目将加强参与者对最近政治和经济动乱对健康的影响以及对格鲁吉亚和前苏联与健康有关问题的回应的了解。

This dissertation project investigates institutional and technological changes in the production of scientific and medical knowledge about tuberculosis (TB) in Soviet Georgia. It examines the impacts of social and political instability on healthcare reform and on the experiences of healthcare practitioners with processes of national reconstruction in scientific and medical settings. Georgia, like much of the former Soviet Union (FSU) is currently facing widespread epidemics of TB and multidrug-resistant TB (MDR-TB). Massive social and economic changes throughout the FSU have led to extremely high levels of poverty, crowded living conditions and shortages of food and energy, all of which create the conditions in which TB has become endemic in many parts of the world. With the demise of the Soviet Union came the dismantling of the centralized healthcare infrastructure. Severe shortages in technological resources necessary to effectively treat and control TB, and in the financial resources necessary to pay healthcare practitioners, to obtain basic diagnostic and treatment supplies and to otherwise maintain stable biomedical research and treatment facilities present great difficulties for local healthcare systems. Georgia is in the throws of a severe energy crisis and political and economic upheavals that persist after years of interethnic conflicts. The cultural, political and economic conditions fuel the spread of TB and further complicate healthcare reform in general and TB eradication in particular. This health crisis has drawn a great deal of attention from the World Health Organization (WHO) and other members of the international health community, as well as other Western European and US based humanitarian aid agencies such as SOROS and USAID. They are working to coordinate efforts with a heterogeneous constellation of locally and internationally based public and private aid organizations, hospitals, labs, pharmaceutical corporations and governmental organizations to implement the standardization of WHO-based management and treatment strategies. By employing ethnographic methods of participant observation, interviews and document analysis within this network of labs, clinics and administrative sites, the researcher will pursue three main goals. Specifically: 1) to map the changing constellation of actors populating the landscape of knowledge production about TB in Georgia and the transnational routes and relationships through which they travel and interact; 2) to understand the processes through which "western" scientific and medical discourses, technologies and practices take on local meaning in the Georgian context and 3) to thus understand larger processes of decentralization and national reconstruction via the lens of healthcare reform in general, and of changing institutional and technological aspects of TB management and control strategies in particular. This research will contribute to an understanding of these processes, and to the inseparability of the organization and distribution of biomedical institutions and resources from local and global cultural, political and economic forces. As a cultural approach to biomedical knowledge production concerning infectious diseases, this project will enhance participants' understandings of the effects of recent political and economic upheavals on health and on responses to health-related issues in Georgia and the former Soviet Union.