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Free Market Tuberculosis

Managing Epidemics in Post-Soviet Georgia

Erin Koch

Publication Year: 2013

The Soviet health care infrastructure and its tuberculosis-control system were anchored in biomedicine, but the dire resurgence of tuberculosis at the end of the twentieth century changed how experts in post-Soviet nations--and globally--would treat the disease. As Free Market Tuberculosis dramatically demonstrates, market reforms and standardized treatment programs have both influenced and undermined the management of tuberculosis care in the now-independent country of Georgia. The alarming rate of tuberculosis infection in this nation at the crossroads of Eastern Europe and Asia cannot be disputed, and yet solutions to attacking the disease are very much debated.
Anthropologist Erin Koch explores the intersection of the nation's extensive medical history, the effects of Soviet control, and the highly standardized yet poorly regulated treatments promoted by the World Health Organization. Although statistics and reports tell one story--a tale of success in Georgia--Koch's ethnographic approach reveals all facets of this cautionary tale of a monolithic approach to medicine.
This book is the 2011 recipient of the annual Norman L. and Roselea J. Goldberg Prize for the best project in the area of medicine.

Published by: Vanderbilt University Press


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pp. 1-3

Title Page

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pp. 4-7


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pp. vii-viii

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pp. ix-xii

I am humbled by the generosity of everyone who helped make possible my research and its completion with this book. I express my deepest gratitude to everyone in Tbilisi who assisted me, especially at the National Tuberculosis Program (NTP), the International Committee of the Red Cross (ICRC), and other NGO and aid workers locally involved with...

Acronyms and Abbreviations

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pp. xiii-xiv

Note on Transliteration

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pp. xiv-17

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pp. 1-32

We live in a world of antibiotic-resistant tuberculosis (and more widespread antibiotic resistance) so overwhelming and alarming that public health experts have predicted the “end of the antibiotic era,” and questioned whether we are already in a “post-antibiotic era” (Alanis 2005).1 Given the ongoing spread of not only multidrug-resistant tuberculosis...

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1. The Hand of Medea: Georgian Medicine in Historical Consciousness

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pp. 33-63

To commute to the NTP I would usually travel by Metro or marshrut’k’a (routed minibus) to Vagzlis Moedani (Vagzali Square), a large square in close proximity to.1 Vagzlis Moedani is also home to the city’s main railway station and provides a transfer point between the two lines of the Tbilisi subway, making it a bustling and heavily trafficked area. Until...

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2. Medicines on the Market

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pp. 64-108

In 2000 during my first trip to Georgia, Dr. Kapanadze invited me to tour the facilities of the NTP. Entering the children’s hospital on my third afternoon in Tbilisi, Ek’a, one of the NTP’s administrative staff members, took me to meet Dato, the head of the pediatric division. We walked...

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3. Rendering Tuberculosis: Managing Microbes and Everyday Laboratory Work

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pp. 109-151

It was a typically hot, dusty, and dry summer in Tbilisi in 2001 when I began my intensive research in the National Reference Laboratory (NRL) at the NTP. Many people had left the city to visit relatives in the mountains, in the wine country to the east, or along the Black Sea coast....

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4. Free Market Tuberculosis Incarcerated

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pp. 152-188

In the summer of 2002 I accepted an invitation from the head of the ICRC TB program to visit sites of detention where TB treatment services had recently been introduced. The head of the program and one of its Georgian physicians thought my research would benefit if I could see the...

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pp. 189-198

The Global Tuberculosis Emergency declared by the WHO in 1993 brought renewed attention to an infectious disease that had been subject to decades of public health neglect, in part because of misguided optimism about its near-eradication. As the global health industry extends...


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pp. 199-206


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pp. 207-224


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pp. 225-231

E-ISBN-13: 9780826518941
E-ISBN-10: 082651894X
Print-ISBN-13: 9780826518927

Page Count: 240
Publication Year: 2013