Chronic Failures

Kidneys, Regimes of Care, and the Mexican State

By Ciara Kierans

SERIES: Medical Anthropology

Rutgers University Press

Chronic Failures: Kidneys, Regimes of Care and the Mexican State is about Chronic Kidney Disease (CKD) and the relentless search for renal care lived out in the context of poverty, inequality and uneven welfare arrangements. Based on ethnographic research conducted in the state of Jalisco, this book documents the routes uninsured Mexican patients take in order to access resource intensive biotechnical treatments, that is, different modes of dialysis and organ transplantation. It argues that these routes are normalized, bureaucratically, socially and epidemiologically, and turned into a locus for exploitation and profit. Without a coherent logic of healthcare access, negotiating regimes of renal care has catastrophic consequences for those with the least resources to expend in that effort. In carrying both the costs and the burden of care, the practices of patients without entitlement offer a critical vantage point on the interplay between the state, markets in healthcare and the sick body.

‘Chronic Failures unfolds a chilling account of the pathological regimes of renal care in Jalisco, Mexico, written in taut prose that is at once theoretically incisive and full of telling ethnographic texture. Moving deftly across the specific and entangled relations of bodies, markets, and state, this book brilliantly weaves together clinical paper-work and polluted lake water, pharmaceutical tianguis and charitable billionaires, media scandals and a mysterious new form of chronic kidney failure into a compelling indictment of the mirage of biomedical salvation. Kierans lays bare how sickness itself is made into a form of consuming labor – one that more often produces hardship and harm rather than health.’ Megan Crowley-Matoka, author of Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico

Kierans offers an extraordinary portrait of the challenges underlying efforts to survive kidney failure in Mexico. 'Regimes of care' extend far beyond clinical interventions, incorporating (and insisting upon) the ongoing labors of kin, including the transport challenges of ongoing dialysis treatments, the oppressive cost of immunosuppressant drugs post-transplant, the limits of universal insurance and its bureaucratic burdens, and even the necessity of having a microwave at home. This beautifully written, thought-provoking work stands out as an important contribution to social scientists’ writings on the sociomedical dimensions of organ failure, healthcare disparities, and on the entanglement of suffering and hope. Lesley A. Sharp, author of The Transplant Imaginary

the book is sensitive to multiple theoretical lenses that unpack the rich ethnographic details in the local complex settings. It is a must-read for those interested in medical anthropology, clinical nephrology, science and technology studies, global health, and biomedical ethics as it shows how organ transplantation, a 'miracle' medicine of the twentieth century, actually exploits the poor. Medical Anthropology Quarterly

CIARA KIERANS is a reader in social anthropology in the Department of Public Health and Policy at the University of Liverpool in the United Kingdom. She is the coauthor of Social and Cultural Perspectives on Health, Technology and Medicine: Old Concepts, New Problems.

Foreword by Lenore Manderson
Prologue
Introduction
Encountering Regimes of Renal Care: The Crucible of Experience
Chapter One
Studying Regimes of Renal Care
Chapter Two
Biopolitics and the Analytics of a Population on the Move
Chapter Three
Labor: Producing Sickness and the State
Chapter Four
Brokering Healthcare: Paper-work, Negotiation and the Strategies of Navigation
Chapter Five
Exchange: Bodies as Sites for the Production of (Surplus) Value
Chapter Six
Transplant Scandals, the State and the ‘Multiple Problematics’ of Accountability
Chapter Seven
Political and Corporate Etiologies: Producing Disease Emergence and Disease Response
Epilogue
References

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