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

本论文项目调查制度和技术变化在生产的科学和医学知识的结核病（TB）在苏联格鲁吉亚。它研究了社会和政治不稳定对医疗改革的影响，以及在科学和医疗环境中国家重建过程中医疗从业人员的经验。与前苏联的许多国家一样，格鲁吉亚目前正面临结核病和耐多药结核病的广泛流行。整个FSU的巨大社会和经济变化导致了极度贫困、拥挤的生活条件以及粮食和能源短缺，所有这些都为结核病在世界许多地方成为流行病创造了条件。随着苏联的解体，中央集权的医疗基础设施也随之解体。有效治疗和控制结核病所需的技术资源严重短缺，支付医疗从业人员、获得基本诊断和治疗用品以及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，给当地医疗保健系统带来了巨大困难。经过多年的种族间冲突，格鲁吉亚正处于严重的能源危机以及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，并使一般的医疗改革，特别是根除结核病进一步复杂化。这场卫生危机引起了世界卫生组织（世卫组织）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）的极大关注。他们正在努力与各种各样的地方和国际公共和私人援助组织、医院、实验室、制药公司和政府组织协调努力，以实施以世卫组织为基础的管理和治疗战略的标准化。通过在这个实验室、诊所和行政站点的网络中采用参与者观察、访谈和文件分析的民族志方法，研究人员将追求三个主要目标。具体而言：1)绘制格鲁吉亚结核病知识生产格局中不断变化的行动者星座，以及他们旅行和互动的跨国路线和关系；2)了解“西方”科学和医学话语、技术和实践在格鲁吉亚背景下具有当地意义的过程；3)因此，通过一般的医疗改革，特别是结核病管理和控制战略的制度和技术方面的变化，了解权力下放和国家重建的更大过程。这项研究将有助于了解这些过程，并有助于了解生物医学机构和资源的组织和分布与当地和全球文化、政治和经济力量的不可分割性。作为生产传染病生物医学知识的一种文化方法，该项目将增进参与者对格鲁吉亚和前苏联境内最近的政治和经济动荡对健康以及对与健康有关的问题的对策的影响的理解。

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.