Abstrakt
This paper, based on fieldwork conducted between 2011–2013, deals with the attitudes of the inhabitants of Bishkek to the health care system and its reforms implemented in post-Soviet Kyrgyzstan, and focuses on emotional factors that influence people’s health-seeking strategies in the context of medical pluralism. I outline the aims and results of the reforms and their evaluation by international and local experts, and confront their opinions with assessments made by the “ordinary” people. In my view, an apparent discrepancy between the official and popular views is due mainly to uncertainty and anxiety related to political instability and economic difficulties of the country, paired with general distrust in medical institutions and, particularly, in professional and moral standards of doctors. Corruption, greed and incompetence of physicians are mentioned among the causes that make therapeutic encounters risky. Such common approach leads to the often observed “doctor-avoiding strategies” and contributes to the increase in popularity of complementary medicine. I discuss some tactics and strategies employed by the people when coping with health problems in those circumstances. As I argue, despite some evident success in reforming health care system, it is important both to recognize its faults and deficiencies, and to take into account emotional factors that significantly shape people’s choices.
Bibliografia
Aronson Polina 2007, Rejecting professional medicine in contemporary Russia, Vestnik. The Journal of Russian and Asian Studies, issue 6, (http://www.sras.org/rejecting_professional_medicine_in_contemporary_russia, 5.06.2013)
Baschieri Angela, Falkingham Jane 2006, Formalizing informal payments: the progress of health reform in Kyrgyzstan, Central Asian Survey, vol. 25, no. 4, s. 441–460
Borowitz Michael 1995, Reinverting the pyramid: reforming primary health care in NIS health systems, Vital Signs, issue 2, s. 1–4, 10
Borowitz Michael, Atun Rifat 2006, The unfinished journey from Semashko to Bismarck: health reform in Central Asia from 1991 to 2006, Central Asian Survey, vol. 25, no. 4, s. 419–440
Csordas J. Thomas 1997, The sacred self: a cultural phenomenology of charismatic healing, University of California Press, Berkeley–Los Angeles
Desmond Nicola, Prost Audrey, Wight Daniel 2012, Managing risk through treatment-seeking in rural north-western Tanzania: categorising health problems as malaria and nzoka, Health, Risk and Society, vol. 14, issue 2, s. 149–170
Douglas Mary 1990, Risk as a forensic resource, Daedalus, vol. 119, no. 4, s. 1–16
Falkingham Jane, Akkazieva Baktygul, Baschieri Angela 2010, Trends in out-of-pocket payments for health care in Kyrgyzstan, 2001–2007, Health Policy and Planning, vol. 25, issue 5, s. 427–436
Field Mark G. 2002, The Soviet legacy: the past as a prologue, [w:] Health Care in Central Asia, red. M. McKee, J. Healy, J. Falkingham, European Observatory on Health Care System Series, WHO, Open University Press, Buckingham–Philadelphia, s. 67–75
Grimen Harald 2009, Power, trust, and risk: some reflections on an absent issue, Medical Anthropology Quarterly, vol. 23, issue 1, s. 16–33
Gullette David 2010, The genealogical construction of the Kyrgyz Republic: Kinship, state and “tribalism”, Global Oriental – Brill, Folkestone
Health... 2011, Health care sector in Kyrgyzstan, (www.musavirlikler.gov.tr/.../Health%20care%20sector%20in%20Kyr... 20.02.2013)
Heyat Farideh 2004, Re-Islamisation in Kyrgyzstan: gender, new poverty and the moral dimension, Central Asian Survey, vol. 23, no. 3–4, s. 275–287
Holdsworth Julia 2004, Exploring and representing uncertainty: the demand to create order from chaos, Anthropology Matters Journal, vol. 6, no. 2, s. 1–10
Ibraimova Ainura, Akkazieva Baktygul, Ibraimov Aibek, Manzhieva Elina, Rechel Bernd 2011a, Kyrgyzstan. Health system review, Health Systems in Transition, vol. 13, no. 3, s. 1–152
Ibraimova Ainura, Akkazieva Baktygul, Murzalieva Gulgun, Balabanova Dina 2011b, Kyrgyzstan: a regional leader in health system reform, [w:] ‘Good health at low cost’ 25 years on. What makes a successful health system?, red. D. Balabanova, M. McKee, A. Mills, London School of Hygiene & Tropical Medicine, London, s. 117–157
Isaev Kusein, Borsokbaeva Sabyrkul’, Moldokeeva Ženišgul’ 2001, Osobennosti sostoâniâ zdorov’â naseleniâ Kyrgyzstana v sovremennyh usloviâh, (http://www.llh.at/llh_project_publications.html, 3.06.2013)
Isaev Kusein, Borsokbaeva Sabyrkul’, Usubalieva Bermet, Alimbekova Gul’žan, Drobyševa Mariâ 2013a, Ob”ektyvnye pokazateli i sub”ektyvnye ocenki izmeneniâ uslovij žizni žitelâmi Kyrgyzstana, [w:] Zdorov’e naseleniâ i social’nye peremeny v postsovetskih gosudarstvah, red. P. Brigadin i in., GIUST BGU, Minsk, s. 230–247
Isaev Kusein, Borsokbaeva Sabyrkul’, Usubalieva Bermet 2013b, Obraz žizni i zdorov’e žitelej Kyrgyzstana v èpohu peremen i social’nyh potrâsenij, [w:] Zdorov’e naseleniâ i social’nye peremeny v postsovetskih gosudarstvah, red. P. Brigadin i in., GIUST BGU, Minsk, s. 247–260
Johnson Erica J. 2009, Authoritarian regimes and nongovernmental organizations: transitions in health care provision in Central Asia, Doctoral dissertation, ProQuest, Ann Arbor
Leavitt John 2012, Znaczenie i czucie w antropologii emocji, przeł. A. Kościańska, M. Petryk, [w:] Emocje w kulturze, red. M. Rajtar, J. Straczuk, Wydawnictwa Uniwersytetu Warszawskiego, Narodowe Centrum Kultury, Warszawa, s. 59–99
Lindquist Galina 2006, Conjuring hope: magic and healing in contemporary Russia, Berghahn Books, New York–Oxford
McEuen Mark 2004, The pilot process: case study on piloting complex health reforms in Kyrgyzstan, Partners for Health Reformplus, Betsheda–Maryland
Ozimek Jakub 2011, Medycyna komplementarna w Kirgistanie – między szamanizmem a islamem ludowym, [w:] Kirgistan. Problemy kulturowe i społeczno-polityczne, red. A. K. Džusupbekov, W. Jakubowski, P. Załęski, Wydział Dziennikarstwa i Nauk Politycznych Uniwersytetu Warszawskiego, Biszkek–Warszawa, s. 79–94
Parkin David 2011, Trust talk and alienable talk in healing: a problem of medical diversity, MMG Working Paper 11–11, Max Planck Institute for the Study of Religious and Ethnic Diversity, Göttingen
Pelkmans Mathijs 2005, Clairvoyants and healers in Kyrgyzstan: new guises and uses of an old profession, (referat wygłoszony na konferencji Popular religiosity after socialism, Czerniejewo, maj 2005 – maszynopis w zbiorach autorki)
Penkala-Gawęcka Danuta 2002, Korean medicine in Kazakhstan: ideas, practices and patients, [w:] Countervailing creativity: patient agency in the globalisation of Asian medicines, red. E. Hsu, E. Høg, Special Issue, Anthropology & Medicine, vol. 9, no. 3, s. 315–336
Penkala-Gawęcka Danuta 2006, Medycyna komplementarna w Kazachstanie. Siła tradycji i presja globalizacji, Wydawnictwo Naukowe UAM, Poznań
Penkala-Gawęcka Danuta 2012, Profesjonalizacja czy zwrot ku „tradycji”? Problemy legitymizacji praktyków medycyny komplementarnej w postsowieckim Kazachstanie i Kirgistanie, [w:] W zdrowiu i w chorobie...Z badań antropologii medycznej i dyscyplin pokrewnych, red. D. Penkala-Gawęcka, I. Main, A. Witeska-Młynarczyk, KNE PAN, Biblioteka Telgte, Poznań, s. 305–330
Rajtar Małgorzata, Straczuk Justyna 2012, Wprowadzenie, [w:] Emocje w kulturze, red. M. Rajtar, J. Straczuk, Wydawnictwa Uniwersytetu Warszawskiego, Narodowe Centrum Kultury, Warszawa, s. 7–21
Rivkin-Fish Michele 2005, Bribes, gifts and unofficial payments: rethinking corruption in post-Soviet Russian health care, [w:] Corruption: anthropological perspectives, red. D. Haller, C. Shore, Pluto Press, London–Ann Arbor, s. 47–64
Ruget Vanessa 2007, Social rights and citizenship in Kyrgyzstan: a communitarian perspective, [w:] Theorising social change in post-Soviet countries. Critical approaches, red. B. Sanghera, S. Amsler, T. Yarkova, Peter Lang, Bern, s. 61–85
Schüth Tobias 2000, “If we were the minister of health...” People’s perspectives on health care, Kyrgyz-Swiss Health Reform Support Project, Swiss Red Cross, Bishkek
Steimann Bernd 2011, Making a living in uncertainty: agro-pastoral livelihoods and institutional transformations in post-socialist rural Kyrgyzstan, Dept. of Geography, University of Zurich, Zürich
Stickley Andrew, Koyanagi Ai, Richardson Erica, Roberts Bayard, Balabanova Dina, McKee Martin 2013, Prevalence and factors associated with the use of alternative (folk) medicine practitioners in 8 countries of the former Soviet Union, BMC Complementary and Alternative Medicine, vol. 13, no. 83 (http://www.biomedcentral.com/1472-6882/13/83, 12.03.2014)
Toktogulova Mucaram 2007, Syncretism of beliefs (Kyrgyzchylyk and Musulmanchylyk), [w:] Mazar worship in Kyrgyzstan: rituals and practitioners in Talas, red. G. Aitpaeva, A. Egemberdieva, M. Toktogulova, Aigine Research Center, Bishkek, s. 507–518
Tulloch John, Lupton Deborah 2003, Risk and everyday life, Sage, London
Waldram James B. 2000, The efficacy of traditional medicine: current theoretical and methodological issues, Medical Anthropology Quarterly, vol. 14, issue 4, s. 603–625
Waldram James B. 2013, Transformative and restorative processes: revisiting the question of efficacy of indigenous healing, Medical Anthropology: Cross-Cultural Studies in Health and Illness, vol. 32, issue 3, s. 191–207
Zinn Jens O. 2006, Risk, affect and emotion, Forum: Qualitative Social Research, vol. 7, no. 1, (http://www.qualitative-research.net/index.php/fqs/article/view/67/138, 4.02.2013)
(European Observatory on Health Systems and Policies), 5.11.2013
(AKIpress, Diskussii o zdravoohranenii i nauke), 7.11.2012
(AKIpress), 8.11.2012
Baschieri Angela, Falkingham Jane 2006, Formalizing informal payments: the progress of health reform in Kyrgyzstan, Central Asian Survey, vol. 25, no. 4, s. 441–460
Borowitz Michael 1995, Reinverting the pyramid: reforming primary health care in NIS health systems, Vital Signs, issue 2, s. 1–4, 10
Borowitz Michael, Atun Rifat 2006, The unfinished journey from Semashko to Bismarck: health reform in Central Asia from 1991 to 2006, Central Asian Survey, vol. 25, no. 4, s. 419–440
Csordas J. Thomas 1997, The sacred self: a cultural phenomenology of charismatic healing, University of California Press, Berkeley–Los Angeles
Desmond Nicola, Prost Audrey, Wight Daniel 2012, Managing risk through treatment-seeking in rural north-western Tanzania: categorising health problems as malaria and nzoka, Health, Risk and Society, vol. 14, issue 2, s. 149–170
Douglas Mary 1990, Risk as a forensic resource, Daedalus, vol. 119, no. 4, s. 1–16
Falkingham Jane, Akkazieva Baktygul, Baschieri Angela 2010, Trends in out-of-pocket payments for health care in Kyrgyzstan, 2001–2007, Health Policy and Planning, vol. 25, issue 5, s. 427–436
Field Mark G. 2002, The Soviet legacy: the past as a prologue, [w:] Health Care in Central Asia, red. M. McKee, J. Healy, J. Falkingham, European Observatory on Health Care System Series, WHO, Open University Press, Buckingham–Philadelphia, s. 67–75
Grimen Harald 2009, Power, trust, and risk: some reflections on an absent issue, Medical Anthropology Quarterly, vol. 23, issue 1, s. 16–33
Gullette David 2010, The genealogical construction of the Kyrgyz Republic: Kinship, state and “tribalism”, Global Oriental – Brill, Folkestone
Health... 2011, Health care sector in Kyrgyzstan, (www.musavirlikler.gov.tr/.../Health%20care%20sector%20in%20Kyr... 20.02.2013)
Heyat Farideh 2004, Re-Islamisation in Kyrgyzstan: gender, new poverty and the moral dimension, Central Asian Survey, vol. 23, no. 3–4, s. 275–287
Holdsworth Julia 2004, Exploring and representing uncertainty: the demand to create order from chaos, Anthropology Matters Journal, vol. 6, no. 2, s. 1–10
Ibraimova Ainura, Akkazieva Baktygul, Ibraimov Aibek, Manzhieva Elina, Rechel Bernd 2011a, Kyrgyzstan. Health system review, Health Systems in Transition, vol. 13, no. 3, s. 1–152
Ibraimova Ainura, Akkazieva Baktygul, Murzalieva Gulgun, Balabanova Dina 2011b, Kyrgyzstan: a regional leader in health system reform, [w:] ‘Good health at low cost’ 25 years on. What makes a successful health system?, red. D. Balabanova, M. McKee, A. Mills, London School of Hygiene & Tropical Medicine, London, s. 117–157
Isaev Kusein, Borsokbaeva Sabyrkul’, Moldokeeva Ženišgul’ 2001, Osobennosti sostoâniâ zdorov’â naseleniâ Kyrgyzstana v sovremennyh usloviâh, (http://www.llh.at/llh_project_publications.html, 3.06.2013)
Isaev Kusein, Borsokbaeva Sabyrkul’, Usubalieva Bermet, Alimbekova Gul’žan, Drobyševa Mariâ 2013a, Ob”ektyvnye pokazateli i sub”ektyvnye ocenki izmeneniâ uslovij žizni žitelâmi Kyrgyzstana, [w:] Zdorov’e naseleniâ i social’nye peremeny v postsovetskih gosudarstvah, red. P. Brigadin i in., GIUST BGU, Minsk, s. 230–247
Isaev Kusein, Borsokbaeva Sabyrkul’, Usubalieva Bermet 2013b, Obraz žizni i zdorov’e žitelej Kyrgyzstana v èpohu peremen i social’nyh potrâsenij, [w:] Zdorov’e naseleniâ i social’nye peremeny v postsovetskih gosudarstvah, red. P. Brigadin i in., GIUST BGU, Minsk, s. 247–260
Johnson Erica J. 2009, Authoritarian regimes and nongovernmental organizations: transitions in health care provision in Central Asia, Doctoral dissertation, ProQuest, Ann Arbor
Leavitt John 2012, Znaczenie i czucie w antropologii emocji, przeł. A. Kościańska, M. Petryk, [w:] Emocje w kulturze, red. M. Rajtar, J. Straczuk, Wydawnictwa Uniwersytetu Warszawskiego, Narodowe Centrum Kultury, Warszawa, s. 59–99
Lindquist Galina 2006, Conjuring hope: magic and healing in contemporary Russia, Berghahn Books, New York–Oxford
McEuen Mark 2004, The pilot process: case study on piloting complex health reforms in Kyrgyzstan, Partners for Health Reformplus, Betsheda–Maryland
Ozimek Jakub 2011, Medycyna komplementarna w Kirgistanie – między szamanizmem a islamem ludowym, [w:] Kirgistan. Problemy kulturowe i społeczno-polityczne, red. A. K. Džusupbekov, W. Jakubowski, P. Załęski, Wydział Dziennikarstwa i Nauk Politycznych Uniwersytetu Warszawskiego, Biszkek–Warszawa, s. 79–94
Parkin David 2011, Trust talk and alienable talk in healing: a problem of medical diversity, MMG Working Paper 11–11, Max Planck Institute for the Study of Religious and Ethnic Diversity, Göttingen
Pelkmans Mathijs 2005, Clairvoyants and healers in Kyrgyzstan: new guises and uses of an old profession, (referat wygłoszony na konferencji Popular religiosity after socialism, Czerniejewo, maj 2005 – maszynopis w zbiorach autorki)
Penkala-Gawęcka Danuta 2002, Korean medicine in Kazakhstan: ideas, practices and patients, [w:] Countervailing creativity: patient agency in the globalisation of Asian medicines, red. E. Hsu, E. Høg, Special Issue, Anthropology & Medicine, vol. 9, no. 3, s. 315–336
Penkala-Gawęcka Danuta 2006, Medycyna komplementarna w Kazachstanie. Siła tradycji i presja globalizacji, Wydawnictwo Naukowe UAM, Poznań
Penkala-Gawęcka Danuta 2012, Profesjonalizacja czy zwrot ku „tradycji”? Problemy legitymizacji praktyków medycyny komplementarnej w postsowieckim Kazachstanie i Kirgistanie, [w:] W zdrowiu i w chorobie...Z badań antropologii medycznej i dyscyplin pokrewnych, red. D. Penkala-Gawęcka, I. Main, A. Witeska-Młynarczyk, KNE PAN, Biblioteka Telgte, Poznań, s. 305–330
Rajtar Małgorzata, Straczuk Justyna 2012, Wprowadzenie, [w:] Emocje w kulturze, red. M. Rajtar, J. Straczuk, Wydawnictwa Uniwersytetu Warszawskiego, Narodowe Centrum Kultury, Warszawa, s. 7–21
Rivkin-Fish Michele 2005, Bribes, gifts and unofficial payments: rethinking corruption in post-Soviet Russian health care, [w:] Corruption: anthropological perspectives, red. D. Haller, C. Shore, Pluto Press, London–Ann Arbor, s. 47–64
Ruget Vanessa 2007, Social rights and citizenship in Kyrgyzstan: a communitarian perspective, [w:] Theorising social change in post-Soviet countries. Critical approaches, red. B. Sanghera, S. Amsler, T. Yarkova, Peter Lang, Bern, s. 61–85
Schüth Tobias 2000, “If we were the minister of health...” People’s perspectives on health care, Kyrgyz-Swiss Health Reform Support Project, Swiss Red Cross, Bishkek
Steimann Bernd 2011, Making a living in uncertainty: agro-pastoral livelihoods and institutional transformations in post-socialist rural Kyrgyzstan, Dept. of Geography, University of Zurich, Zürich
Stickley Andrew, Koyanagi Ai, Richardson Erica, Roberts Bayard, Balabanova Dina, McKee Martin 2013, Prevalence and factors associated with the use of alternative (folk) medicine practitioners in 8 countries of the former Soviet Union, BMC Complementary and Alternative Medicine, vol. 13, no. 83 (http://www.biomedcentral.com/1472-6882/13/83, 12.03.2014)
Toktogulova Mucaram 2007, Syncretism of beliefs (Kyrgyzchylyk and Musulmanchylyk), [w:] Mazar worship in Kyrgyzstan: rituals and practitioners in Talas, red. G. Aitpaeva, A. Egemberdieva, M. Toktogulova, Aigine Research Center, Bishkek, s. 507–518
Tulloch John, Lupton Deborah 2003, Risk and everyday life, Sage, London
Waldram James B. 2000, The efficacy of traditional medicine: current theoretical and methodological issues, Medical Anthropology Quarterly, vol. 14, issue 4, s. 603–625
Waldram James B. 2013, Transformative and restorative processes: revisiting the question of efficacy of indigenous healing, Medical Anthropology: Cross-Cultural Studies in Health and Illness, vol. 32, issue 3, s. 191–207
Zinn Jens O. 2006, Risk, affect and emotion, Forum: Qualitative Social Research, vol. 7, no. 1, (http://www.qualitative-research.net/index.php/fqs/article/view/67/138, 4.02.2013)
(European Observatory on Health Systems and Policies), 5.11.2013
(AKIpress, Diskussii o zdravoohranenii i nauke), 7.11.2012
(AKIpress), 8.11.2012