Care

Antibiotics often take the form of care in contemporary life. They are objects that ‘care’ for our sick and vulnerable. Giving antibiotics, then, is often a central way that caregivers perform their care.

Antibiotics often take the form of care in contemporary life. They are objects that ‘care’ for our sick and vulnerable. Giving antibiotics, then, is often a central way that caregivers perform their care.

From a physician with limited time for a patient, to a parent with a sick child running out the door to work, or even the humanitarian necessity of bestowing affordable pharmaceuticals on the developing world, antibiotics are a central part of how we give and receive what we think of as ‘good care’.

We often assume that care decisions around antimicrobial use happen in the clinic, between physician and patient. Research demonstrates, however, that globally these care decisions most often occur outside of the clinic, within families, informal ‘drug shops’, or social networks. Mark Nichter’s (2001) ethnographic research in the Philippines, for example, provides a rich description of preventive and protective antibiotic use by patrons of sex workers, who variously took antibiotics before sex, after sex, occasionally or routinely depending upon their own situations and familiarity with the particular sex worker. His analysis demonstrates how the use and care around antibiotics is made within the context of vulnerability, stigma, and perceived harm-reduction.

In anthropology, we say then that care is situated and contextual. This means that we can’t take for granted people’s reasoning, and instead we need to consider the wider picture: What are the particularities, immediate details, socioeconomic or cultural factors behind a certain care decision or form of antibiotic use? A decision about antibiotic use, sex work and sexually transmitted infections is not a singular problem of seeking out the right treatment, but involves a careful consideration of desire for anonymity, gender norms and/or individual safety. The anthropologist Arthur Kleinman has further elaborated on how the context of care shapes the meaning of medicines for both providers and patients. Kleinman’s professional, folk and popular sectors model demonstrate how different social relations as well as clinical realities are key characteristics in use of medicines (Kleinman 1980).

While ‘rational use’ has defined the majority of policy undertakings over the past few decades, anthropologists are providing evidence of consumers’ own rationalities for use of medicines and care decisions. It is easy to fall into the trap of casting these behaviours as ‘misguided’, but by highlighting the institutional, ethical, and everyday forms of care that hinge on antimicrobial use (and vice versa), we open a space to think differently – about care and its contexts. How do the contexts of care shape our interpretation of antimicrobial resistance (AMR).