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

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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.