Enveloped Lives PDF Download

This dissertation is an ethnography of how people practice health and care by engaging in ambiguous practices that some would define as informal and corrupt. It examines the relationship between caring, things and money. It focuses on how informal payments -"little white envelopes"- that the patients or their relatives give or feel compelled to give to doctors before or after treatment, sustained and maintained public health care in the times of economic shortages during socialism and during the fundamental transformations to capitalism in post-socialist Lithuania. Based on sixteenth month of fieldwork research, this dissertation follows these envelopes as complex doctor-patient transactions, the nexus of relations, to learn about health and care at the intersection of neoliberal reforms and socialist fragmentations. The dissertation traces the genealogy of the health care reform since 1990s, exploring how patients, doctors and caretakers encounter, perceive and carry out these ambiguous practices, and how they negotiate envelopes and professional ethics, biomedicine and political economy through particular notions of care, grounded in desires, anxieties, recognitions, and imaginations. This ethnography shows how envelopes became a form of care embedded in social relations and driven by webs of obligations. These practices are productive in sustaining the lives of doctors and have affective value for patients and doctors alike. They supplement public health care while making doctors reliant on patients0́9 generosity. While the envelopes do not reduce social inequalities, they slow down significantly the transformation of public health care from the social function of the state to a business matter. Therefore, they might preclude the emergence of new inequalities that appear with the adoption of private health care and insurance regimes.