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Antropologi Indonesia

Abstract

The precarity of a nation’s healthcare system often shows its true colours in remote areas, including the frontiers. This lack of stability is also seen in Malinau, where inaccessibility due to inadequate infrastructure leads to a shortage of basic medicines and necessary medical equipment. Coupled with limited healthcare workers, doctors and nurses frequently encounter situations in which they are unable to take care of patients properly. This creates a specific form of moral economy that is inevitably shaped by medical infrastructure. While moral economy in healthcare does not break any new grounds, there is room to explore the dynamics of moral economy in healthcare and its ties to the history and material conditions of the frontiers as a specific form of space. Drawing ethnographic experience with healthcare workers, this article analyses how the reality of healthcare in Malinau leads workers to rely on their senses and experiential knowledge to provide care to patients in need. However, the lack of medical equipment needed to properly diagnose patients demonstrates their limitations. In these situations, speculative thinking comes into play. Moments of uncertainty that arise from speculative thinking can give way to moral dilemmas that might not be reassuring for patients who are in need of care. I argue that the collision between healthcare practices and speculation creates a certain form of moral economy where values of compassion and the humanitarian rationale to save patients meets a brick wall that leads to doubt, frustration and conflict among healthcare providers.

Bahasa Abstract

Kerawanan sistem kesehatan negara menjadi lebih terlihat di daerah terpencil, termasuk daerah perbatasan. Ketidakstabilan ini juga terlihat di Malinau. Kurangnya akses terhadap infrastruktur yang memadai menyebabkan kurangnya obat-obatan dan alat kesehatan. Ditambah keterbatasan tenaga kesehatan, dokter dan perawat seringkali berada di kondisi dimana mereka tidak bisa merawat pasien dengan baik. Kondisi ini melahirkan suatu ekonomi moral spesifik yang terbentuk karena kondisi infrastruktur kesehatan. Walaupun ekonomi moral dalam kesehatan bukan konsep yang baru, penelitian mengenai dinamika ekonomi moral dalam kesehatan dan kaitannya dengan kondisi material dan sejarah daerah perbatasan merupakan suatu hal yang layak untuk dieksplorasi. Melalui observasi partisipasi dan wawancara mendalam, artikel ini menganalisis realita sistem kesehatan di Malinau yang terpaksa bergantung pada panca indra dan pengalamannya untuk merawat pasien yang membutuhkan. Walaupun keterampilan ini cukup membantu, keterbatasannya terlihat karena mereka kekurangan alat kesehatan yang dibutuhkan untuk mendiagnosa pasien dengan benar, terutama untuk penderita dengan kasus kompleks. Situasi yang tidak pasti melahirkan pemikiran spekulatif antara tenaga kesehatan. Pemikiran spekulatif seringkali membuat situasi yang tidak meyakinkan buat pasien yang sedang membutuhkan perawatan. Tulisan ini berargumen bahwa praktik kepedulian dan spekulasi membentuk suatu ekonomi moral. Tenaga Kesehatan di Malinau tidak bisa mengekspresikan nilai-nilai kepedulian dan dorongan untuk membantu, sehingga perasaan ragu-ragu, frustrasi, dan konflik tumbuh antar tenaga kesehatan.

References

The Care Collective. The Care Manifesto: The Politics of Interdependence. Verso, 2020.

Fassin, Didier. “Humanitarianism as a Politics of Life.” Public Culture 19, no. 3 (2007): 499–520. https://doi.org/10.1215/08992363-2007-007.

Fassin, Didier. “Les Économies Morales Revisitées.” Annales. Histoire, Sciences Sociales 64, no. 6 (2009): 1235–66. https://doi.org/10.1017/s0395264900027499.

Fassin, Didier. Life: A Critical User’s Manual. Cambridge, UK: Polity Press, 2018.

Ishikawa, Noboru. Between Frontiers: Nation and identity in a Southeast Asian borderland. NUS Press, 2010.

Lemoine, Benjamin. “No Epistemological Standstill on Sovereign Debt: The Preservation of the Market Order in Pandemic Times.” Essay. In Pandemic Exposures: Economy and Society in the Time of Coronavirus, edited by Didier Fassin and Marion Fourcade, 37–57. HAU Books, 2022.

Livingston, Julie. Improvising medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham N.C.: Duke University Press, 2012.

Mol, Annemarie, Ingunn Moser, and Jeannette Pols. “Care: Putting Practice into Theory.” Essay. In Care in Practice: On Tinkering in Clinics, Homes and Farms, edited by Annemarie Mol, Ingunn Moser, and Jeannette Pols, 7–25. Transcript Verlag, 2010.

Mol, Annemarie. “Ontological Politics. A Word and Some Questions.” The Sociological Review 47 (1999): 74–89. https://doi.org/10.1111/j.1467-954x.1999.tb03483.x.

Mol, Annemarie. the body multiple: ontology in medical practice. Duke University Press, 2002.

Mol, Annemarie. The Logic of Care: Health and the problem of patient choice. Routledge, 2008.

Schendel, Willem van, and Itty Abraham. “Spaces of Engagement: How Borderlands, Illicit Flows, and Territorial States Interlock.” Essay. In Illicit Flows and Criminal Things: States, Borders, and the Other Side of Globalization, edited by Willem van Schendel, 38–68. Indiana University Press, 2005.

Scott, James C. Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed. Yale University Press, 1998.

Scott, James C. The Art of Not Being Governed: An Anarchist History of Upland Southeast Asia. Yale University Press, 2009.

Street, Alice. “Artefacts of Not-Knowing: The Medical Record, the Diagnosis and the Production of Uncertainty in Papua New Guinea Biomedicine.” Social Studies of Science 41, no. 6 (2011): 815–34. https://doi.org/10.1177/0306312711419974.

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