There Is No Place Like Home: Imitation and the Politics of Recognition in Bolivian Obstetric Care

Abstract

This article examines how efforts to "culturally adapt" birthing spaces in a rural Bolivian hospital are generating debates among doctors about what constitutes proper obstetric care. Working at the intersection of national and transnational projects, NGOs in Bolivia have remade the birthing rooms of some public health institutions to look more like a home, with the goal of making indigenous women feel more comfortable and encouraging them to come to the clinic to give birth. Yet narratives of transformation also obscure ongoing conditions of racial and gendered inequality in health services. I demonstrate how doctors' use of culturally adapted technologies enacts shifting affective relations-warm, cold, gentle, harsh-that draws on preoccupations with indigenous culture as a threat to maternal and infant life. In tracing practices of care, I argue that culturally adapted birthing in many ways extends historically rooted practices of doing biomedical work on indigenous bodies.

Bhabha in the clinic

“…Given the impact of both capitalist and political processes on care globally, a postcolonial frame examining those morally charged healing encounters keeps watchful for medical trickery and collusion, biological justifications for inequity, and other repugnant repetitions of Western scientific history. This is part of what is intended by such contentious linguistic frames as 'structural violence' (Farmer 2004), 'the new slavery' (Bales 2004(Bales , 2012, 'settler-colonial logic' (Morgensen 2011;Wolfe 1999), or care as 'anonymous' (Stevenson 2014) or 'cold' (Morales 2018). The capitalist and statist agendas of many healthcare marketplaces, as well as hyperindividualist and progress orientations toward life and health, invite these frankly postcolonial critiques.…”

The pursuit of clinical recognition: Aesthetics, care, and music therapy in North American hospitals

“…Davis, 2019; Desjarlais, 1997; Garcia, 2010; Romero, 2021; Sufrin, 2017). Anthropologists have also considered entanglements between care and recognition, including how cultural recognition (Morales, 2018; Shaw, 2005) and the recognition of personhood (Stevenson, 2014; Taylor, 2008) are at stake in practices of care, as well as the extension of recognition through ethnographic representation as a “care‐full” practice (Cubellis, 2020a). This article asks: How are sociomaterial practices recognized as care and specifically as the specific mode, genre, or style known as clinical care?…”

Gentleness

“…Ethnographically, gentleness has been used to describe demeanor, both carefully (Johnson 2008) and collectively (Mead 2001(Mead [1935). It has been used to characterize an aura that pervades medical interventions (Desjarlais 2014;Morales 2018). Focusing on patients' experiences and politicaleconomic and religious orders show us that care may not be gentle; it can be a form of violence (O'Neill and Fogarty-Valenzuela 2020; Warin 2020).…”