Department of Surgery, Johns Hopkins Hospital, Tower 110 Doctor's Lounge, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Soc Sci Med. 2022 Apr;298:114837. doi: 10.1016/j.socscimed.2022.114837. Epub 2022 Feb 22.
Referral health care refers to the movement of populations between different levels of a health care system, often to seek specialized care at higher level centers. It requires mobility of populations. Critical questions on the shortcomings for accessing referral health care, especially for refugees in sub-Saharan Africa, remain unexplored. How do global guidelines on referral health care play out in the local context of a country like Tanzania, where refugees are not legally allowed to leave the refugee camp without permission? How do health care providers navigate this complex space, and how can we leverage anthropological theories of biopower and therapeutic citizenship to better understand this context? Based on six months of ethnographic fieldwork in Tanzania between 2011 and 2021, I trace how global refugee policy manifests itself locally. I argue that referral for refugees in Tanzania is as much a political and social process as it is medical. The bureaucratic process favors certain pathologies over others and creates significant delays in referral. Triage takes on nuanced forms whereby a certain aspect of a patient's case (i.e., prognosis, cost, age) is privileged in a context of strict refugee policy that restricts independent care-seeking. Most patients are approved for referral, but many are denied. A patient may not be sick enough to merit timely referral, or they may be deemed too sick to prevent referral altogether. Challenging other arguments of therapeutic citizenship where people living with certain health conditions acquire access to certain therapies and their right to health, I show how refugees with certain pathologies are actually excluded from care. These therapeutic exceptions produce consequences whereby bureaucracy and security have prevailed over the right to health and reinforced the power of state sovereignty in what may best be understood not as a therapeutic citizenship, but instead as a therapeutic refugeehood.
转诊医疗保健是指人口在医疗保健系统的不同层次之间的流动，通常是为了在更高层次的中心寻求专业医疗服务。它需要人口的流动性。关于获得转诊医疗保健的不足之处的关键问题，尤其是撒哈拉以南非洲的难民，仍然没有得到探讨。全球转诊医疗保健指南在像坦桑尼亚这样的国家的当地背景下是如何发挥作用的，在坦桑尼亚，难民未经许可不得离开难民营？医疗保健提供者如何在这个复杂的空间中航行，我们如何利用生物权力和治疗性公民身份的人类学理论来更好地理解这一背景？基于 2011 年至 2021 年在坦桑尼亚六个月的民族志实地工作，我追溯了全球难民政策在当地的体现。我认为，坦桑尼亚的难民转诊既是一个政治和社会过程，也是一个医疗过程。官僚程序倾向于某些疾病而不是其他疾病，并且在转诊方面造成了重大延误。分诊采取了微妙的形式，即在严格的难民政策限制独立求医的情况下，优先考虑患者病情的某些方面（即预后、成本、年龄）。大多数患者都被批准转诊，但也有很多人被拒绝。患者可能没有病到需要及时转诊的程度，也可能被认为病得太重，根本无法转诊。我对治疗性公民身份的其他论点提出了挑战，即患有某些疾病的人获得某些治疗方法和他们的健康权利，我展示了患有某些疾病的难民实际上是如何被排除在医疗之外的。这些治疗例外产生了后果，即官僚主义和安全已经胜过健康权，并加强了国家主权的权力，这最好被理解为不是治疗性公民身份，而是治疗性难民身份。
