Farmer Paul Edward - Blind spot: how neoliberalism infiltrated global health

The California Series in Public Anthropology emphasizes the anthropologists role as an engaged intellectual. It continues anthropologys commitment to being an ethnographic witness, to describing, in human terms, how life is lived beyond the borders of many readers experiences. But it also adds a commitment, through ethnography, to reframing the terms of public debatetransforming received, accepted understandings of social issues with new insights, new framings.

Series Editor: Robert Borofsky (Hawaii Pacific University)

Contributing Editors: Philippe Bourgois (University of Pennsylvania), Paul Farmer (Partners In Health), Alex Hinton (Rutgers University), Carolyn Nordstrom (University of Notre Dame), and Nancy Scheper-Hughes (UC Berkeley)

University of California Press Editor: Naomi Schneider

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Blind Spot: How Neoliberalism Infiltrated Global Health, by Salmaan Keshavjee (with a foreword by Paul Farmer)

Blind Spot

HOW NEOLIBERALISM INFILTRATED GLOBAL HEALTH

Salmaan Keshavjee

Foreword by Paul Farmer

UNIVERSITY OF CALIFORNIA PRESS

University of California Press, one of the most distinguished university presses in the United States, enriches lives around the world by advancing scholarship in the humanities, social sciences, and natural sciences. Its activities are supported by the UC Press Foundation and by philanthropic contributions from individuals and institutions. For more information, visit www.ucpress.edu.

University of California Press

Oakland, California

2014 by The Regents of the University of California

Library of Congress Cataloging-in-Publication Data

Keshavjee, Salmaan, 1970 author.

Blind spot : how neoliberalism infiltrated global health / Salmaan Keshavjee ; foreword by Paul E. Farmer.

p. cm. (California series in public anthropology ; 30)

Includes bibliographical references and index.

ISBN 978-0-520-28283-4 (cloth : alk. paper)

ISBN 978-0-520-28284-1 (pbk. : alk. paper)

ISBN 978-0-520-95873-9 (ebook)

I. Title. II. Series: California series in public anthropology ; 30.

[DNLM: 1. Health ServiceseconomicsTajikistan. 2. Health PolicyTajikistan. 3. Health Services AdministrationeconomicsTajikistan. 4. OrganizationsTajikistan. 5. Socioeconomic FactorsTajikistan. 6. World HealthTajikistan. W 84 JT23]

RA395.A783

362.109586dc232014008620

Manufactured in the United States of America

23 22 21 20 19 18 17 16 15 14

10 9 8 7 6 5 4 3 2 1

In keeping with a commitment to support environmentally responsible and sustainable printing practices, UC Press has printed this book on Natures Natural, a fiber that contains 30% post-consumer waste and meets the minimum requirements of ANSI/NISO Z 39.481992 ( R 1997) ( Permanence of Paper ).

For my parents, Sherbanu and Ameer Keshavjee.
Born in apartheid South Africa, they brought us to a place that many in this world can only dream of and taught us to be courageous, persistent, and vigilant in the struggle for equity and justice.

The inner meaning of history ... involves speculation and an attempt to get at the truth, subtle explanation of the causes and origins of existing things, and deep knowledge of the how and why of events. History, therefore, is firmly rooted in philosophy.

Ibn Khaldun, fourteenth-century historian, The Muqaddimah

Fyodor Pavlovitch was drunk when he heard of his wifes death, and the story is that he ran out into the street and began shouting with joy, raising his hands to Heaven: Lord, now lettest Thou Thy servant depart in peace, but others say he wept without restraint like a little child, so much so that people were sorry for him, in spite of the repulsion he inspired. It is quite possible that both versions were true, that he rejoiced at his release, and at the same time wept for her who released him. As a general rule, people, even the wicked, are much more nave and simple-hearted than we suppose. And we ourselves are, too.

Fyodor Dostoyevsky, The Brothers Karamazov

Contents

Paul Farmer

Illustrations

MAP

FIGURES

Foreword

Paul Farmer

It is rare that a scholarly work can be called soul-searching as well as wrenching, but Blind Spot, by physician-anthropologist Salmaan Keshavjee, is just such a book. Based on ethnographic research conducted after the collapse of the Soviet Union, in a remote and mountainous part of Central Asia at the margin of armed conflict, this is a haunting account of a goodwill effort to replace an inadequate public health system with a sustainable (and privatized) one. This new system is to be based, Keshavjee learns, on a post-Communist ideological framework even more impervious to course correction than the one preceding it. Lost in the battle between partisans of competing frameworks, one ascendant and one in the throes of collapse, are the poor and vulnerable and hungry who live in the Pamir Mountains, through which the storied Silk Road improbably winds.