Department of Anthropology, Franklin and Marshall College.
Med Anthropol Q. 2013 Mar;27(1):84-102. doi: 10.1111/maq.12017.
Drawing on participant-observation in Nicaraguan dengue prevention campaigns and a series of semistructured interviews with Nicaraguan health ministry personnel, this article shows how community health workers (CHWs) balanced two kinds of "medical citizenship." In some situations, CHWs acted as professional monitors and models of hygienic behavior. At other times, CHWs acted as compassionate advocates for their poor neighbors. In 2008, Nicaragua's Sandinista government moved to end a long-standing policy of paying CHWs, recasting them as citizen-volunteers in a "popular struggle" against dengue. Although CHWs approved of the revival of grassroots advocacy, they were hostile to the elimination of compensation. Framing this ambivalence as part of CHWs' desire to serve as "brokers" between the poor and the state, I suggest that attention to medical citizenship provides insight into the sometimes contradictory ways in which CHWs engage the participatory health policies now taking hold in Latin America and elsewhere.
本文通过对尼加拉瓜登革热预防运动中的参与式观察和对尼加拉瓜卫生部人员的一系列半结构化访谈，展示了社区卫生工作者（CHWs）如何平衡两种“医疗公民身份”。在某些情况下，CHWs 充当专业的监督者和卫生行为的模范。而在其他时候，CHWs 则充当贫困邻居富有同情心的倡导者。2008 年，尼加拉瓜桑地诺政府决定结束长期以来向 CHWs 支付报酬的政策，将他们重新塑造为一场“人民斗争”中的公民志愿者，以对抗登革热。尽管 CHWs 赞成恢复基层倡导，但他们对取消补偿持敌对态度。本文将这种矛盾心态描述为 CHWs 希望充当“中间人”，将贫困人群与国家联系起来的一部分，认为关注医疗公民身份为理解 CHWs 参与拉丁美洲和其他地区当前流行的参与式卫生政策的有时相互矛盾的方式提供了线索。
