Governing tuberculosis: Competing cultures of disease and medicine in postsocialist Georgia

This dissertation is an anthropological study of tuberculosis control in contemporary Georgia. The former Soviet Union is a "hot zone" in what the World Health Organization (WHO) declared a "Global Tuberculosis Emergency" in 1993. In Georgia the dissolution of the Soviet medical infrastructure, combined with extreme poverty and state collapse have created a situation in which tuberculosis (TB) and other infectious diseases readily spread. This ethnography investigates responses to tuberculosis as a red thread of Soviet-system breakdown and the globalization of market-driven biomedicine. I concentrate on relationships between social upheaval, disease incidence, medical and carceral institutions, and knowledge production.; This study is rooted in fourteen months of ethnographic fieldwork headquartered at the National Tuberculosis Program in Tbilisi, Georgia. Research consisted of interviews with scientists, health care workers, administrators and representatives of international aid organizations, as well as participant-observation research at the central TB Lab, at training sessions, and in the prison sector where tuberculosis cases concentrate.; Tuberculosis management and treatment standards branded and packaged by the WHO as DOTS (Directly Observed Treatment, Short Course) are currently marketed as the only efficient, rational response to TB at present. This dissertation demonstrates that Georgia is a critical site for analyzing the adoption of international TB control principles, as implementation confers legitimacy in influential public health networks and secures resources that state institutions are unable to provide.; Following the introductory chapter detailing the ethnographic context, research methods and central theoretical questions, this dissertation follows the implementation of DOTS---and its effects---in clinical, laboratory and carceral domains. Of central concern are the ways in which global standards are taken up, contested, and transformed to meet local needs among constituents of the Georgian National Tuberculosis Program. Above all, this ethnography demonstrates that tuberculosis is a politically charged zone where contests over resources and forms of expertise materialize. In contemporary Georgia, new modes of governance are created, negotiated, and regulated through responses to tuberculosis and broader practices of healthcare reform. To this process, an "anthropology of the present" has much to contribute.