Productive Pathologies: Professional Patients and the Commodification of Disease in Egypt

这个项目考察了埃及社会中日益增长的“职业病人”现象。它追踪病人的疾病商品化和参与床边教学和评估方案。它表明，随着贫困和失业的增加，一些病人如何在他们的疾病中找到生物价值，并在医学院找到有关他们的市场知识。第一阶段的研究结果表明，从事疾病业务有助于患者获得社会和经济资本，否则无法获得这些资本。它强调，患者对疾病的商品化不仅是恢复其社会地位的工具，也是控制疾病本身的工具。特别是，研究表明：1)医学伦理在患者没有意识到的时候被医疗专业人员所忽视。同时，为了实现他们的职业目标，医疗助理被迫与专业患者合作，以满足老年人向学生展示的需求。2)这种现象是医疗机构的结构性暴力造成的，不满足患者的需求，导致普通患者在教学医院不合作，导致“疾病市场”的繁荣。在疾病商品化的条件下，疾病变成了救世主和伴侣，帮助患者控制疾病本身。在这种情况下，社会福利超过了身体健康。3)疾病商品化赋予患者权力，帮助他们独立，摆脱贫困，承担起照顾家庭的责任。尽管如此，它仍被认为是一种耻辱，需要谨慎处理。一些男性患者倾向于隐瞒自己的疾病活动，而女性患者则会揭露自己的疾病活动，并招募邻居来保护自己的声誉。4)这种“疾病工作”产生了生物社会性，它基于营销疾病和与疾病共存的学习策略。他们还为他们的成员提供安全感和社区。在这些发现的基础上，下一阶段的研究将把疾病作为一种“日常抵抗”形式（Scott 1985）进行调查，其中性别起着至关重要的作用。在这方面，患者参与了一场微妙的无声运动，在国家面前主张权利，恢复他们在家庭中的地位，无论是被授权还是从属。通过特别关注性别的动态，我们建议调查：1)从事这种疾病工作的妇女如何通过采用疾病身份来羞辱那些在离婚或丈夫去世后忽视和抛弃她们的亲属。2)男性通过将自己的疾病商品化，同时获得以其他方式无法获得的医疗服务，声称在医疗机构拥有“服务权利”，从而无声地抵制国家的忽视。

This project examines the growing phenomenon of ‘professional patients’ in Egyptian society. It traces patients’ disease commodification and involvement in bedside teaching and evaluation scenarios. It shows how, with increasing poverty and unemployment, some patients find a biovalue in their diseases and market knowledge about them in medical schools. The findings of the first research phase demonstrate that engaging in a disease business assists patients to have access to social and economic capital, which is inaccessible otherwise. It highlights that patients’ commodification of disease is a tool not only to restore their social position, but to manage the disease itself.In particular, the research shows that: 1) medical ethics are ignored by medical professionals, at a time when patients are not aware of them. At the same time, to meet their career goals, medical assistants are compelled to cooperate with professional patients to satisfy their seniors’ needs to demonstrate to their students. 2) This phenomenon is a result of structural violence in medical institutions that do not cater to the needs of the patients and accordingly ordinary patients are turned uncooperative in teaching hospitals, which leads to the flourishing of a “disease market.” In the conditions of disease commodification, disease is turned into a savior and a companion that helps patients manage the disease itself. Social wellbeing in this case overweighs physical wellbeing. 3) Commodifying disease empowers patients and helps them to become independents, to survive poverty and to take over responsibility for their families. Still it is considered stigmatizing and needs to be navigated carefully. While some male patients tend to conceal their disease activities, female patients reveal them and recruit fellow neighbors to protect their reputation. 4) Biosocialities emerge of such “disease work,” which are based on learning strategies to market disease and live with it. They also provide a sense of security and a community to their members.Building on these findings, the next phase of research will investigate disease as a form of “everyday resistance” (Scott 1985) where gender plays a vital role. In this regard, patients are involved in a subtle silent movement to claim rights in front of the state and to restore their position within the family, whether empowered or subordinate. By focusing particularly on the dynamics of gender, we propose to investigate how: 1) women engage in this disease work to inflict shame on their kin who neglect and abandon them after a divorce or the death of a husband by adopting a disease identity. 2) Men engage in a silent resistance to state’s neglect by claiming the ‘right to service’ in medical institutions by commodifying their diseases while accessing medical service inaccessible otherwise.