Politics and Inequality in Pain Management: The Case of Zimbabwe

我提议的研究针对津巴布韦的痛苦政治及其管理，作为了解社会不平等的窗口。疼痛跨越了鸿沟--它影响着我们所有人，从这个意义上说，它是一个强大的均衡器，但获得临床疼痛管理的机会并不均衡。在全球每年生产的298.5公吨吗啡当量阿片类药物中，平均只有0.1公吨流向低收入国家。虽然缺乏临床疼痛管理，但许多发展中国家的阿片类药物使用障碍(OUD)也在稳步增加。阿片类药物的使用模式反映了社会经济机会的不平等；获得临床护理的机会；对可接受的生活水平和不适程度的判断；以及关于疼痛耐受的种族主义言论。这是一个需要跨学科分析的问题，而社会科学圈在很大程度上忽视了这一点。津巴布韦的殖民历史、几十年的相关政治和经济动荡，以及艾滋病毒/艾滋病和癌症的双重负担，形成了一幅独特的痛苦图景。今天，该国面临着严重缺乏临床疼痛管理和非法阿片类药物使用增加的问题。我提议的研究将探索这些现象，作为了解疼痛管理的政治和不平等以及国内和全球医学的社会生活的窗口。我将回答两个重叠的问题：社会不平等如何塑造痛苦的分布，并调节其管理环境？疼痛管理的主观体验是什么，无论是对于那些遭受痛苦的人，还是那些提供护理的人？因此，我的研究将把痛苦及其管理作为社会和政治进程的表现--作为津巴布韦更广泛的“危机”的一个维度，由跨越地理和时间框架的动态塑造。这一方法将以经验为基础，首先收集有关疼痛分布及其管理情况的数据。这将为在DPHIL第二年的实地考察期间进行的定性访谈和参与者观察提供信息，说明如何在人类层面上解释和体验疼痛及其管理。津巴布韦是一个经历了一系列相关危机余震的后殖民国家，它是一个强大的棱镜，可以用来理解疼痛和阿片类药物的使用模式如何突显出更广泛的不平等政治。我的研究最终将试图阐明这些现象的具体经验，并从这个角度提供更公平和更敏感的止痛系统。

My proposed research addresses the politics of pain and its management in Zimbabwe, as a window onto social inequalities. Pain cuts across divides - it affects us all, and is in this sense a powerful equaliser, but access to clinical pain management is uneven. Of the 298.5 metric tonnes of morphine equivalent opioids produced globally each year, on average only 0.1 metric tonnes go to low-income countries. While clinical pain management is lacking, many developing countries are also experiencing a steady increase in opioid use disorder (OUD). Patterns of opioid use reflect inequalities in socio-economic opportunity; access to clinical care; judgements about acceptable standards of living and levels of discomfort; and racialised discourses about pain tolerance. This is an issue calling for interdisciplinary analysis that has been largely overlooked in social science circles. Zimbabwe's colonial history, decades of related political and economic volatility, and a double burden of HIV/AIDS and cancer have shaped a unique landscape of pain. Today, the country faces a significant lack of clinical pain management and a rise in illicit opioid use. My proposed research will explore these phenomena as a window onto the politics and inequalities of pain management, and the social life of medicine both nationally and globally. I will address two overlapping questions: how do social inequalities shape the distribution of pain, and condition the circumstances of its management? And what is the subjective experience of pain management, both for those who suffer and those who provide care? My research will thus address pain and its management as expressions of social and political processes - as a dimension of Zimbabwe's wider 'crisis', shaped by dynamics that span geographies and timeframes. This approach will be grounded empirically, beginning with the collection of data on the distribution of pain and the circumstances of its management. This will then inform qualitative interviews and participant observation to be carried out during fieldwork in the second year of the DPhil, illustrating how pain and its management are interpreted and experienced on a human level. A post-colonial state experiencing the aftershocks of a string of related crises, Zimbabwe is a powerful prism for understanding how patterns of pain and opioid use highlight a wider politics of inequality. My research will ultimately seek to illustrate the embodied experiences of these phenomena, and from this perspective inform more equitable and sensitive systems of analgesia.