Between policy and patients : protocols and practice in HIV/AIDS treatment
In recent years the World Heath Organisation (WHO) has recomended standardising HIV/AIDS treatment. Standardisation is based upon a particular model of what occurs within the relationship between a doctor and a patient and is propogated through the application of protocols. This thesis aims to illustrate how a doctor deals with a protocol in the face of contexts over-laden with contingency and excess which the protocol does not account for and which standardisation excludes. In other words, it explores how doctors deal with the failures and restrictions of standardised medicine. The central question this thesis aims to answer is: How do doctors on the ground deal with the standardising demands of global, as well as national, institutions in the face of highly contingent daily realities? I aim to answer this question by critically analysing the relationship between global institutions and the effects of their policies on the ground level. I argue that global organisation such as the WHO attempt to limit the particularities and contingency of local contexts in order to ensure the internal coherence of their own policies. This is made possible through ‘interpretive communities’ of experts, as well as, the relative opacity of ground level actions. However, I also illustrate how doctors applying these protocols are not merely pawns in the state’s and global health organisations schemes but rather depend upon the opacity at ground level in order to ensure the well-being of those marginalised by protocols.