Open AccessTHE STRUGGLE FOR HEALTH: Medical Brokerage and the Power of Care in Brazil's Amazon Estuary
Author(s) -
ABEL MATTHEW
Publication year - 2022
Publication title -
cultural anthropology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.669
H-Index - 75
eISSN - 1548-1360
pISSN - 0886-7356
DOI - 10.14506/ca37.3.06
Subject(s) - appropriation , biopower , power (physics) , health care , right to health , political science , amazon rainforest , sociology , law , politics , philosophy , linguistics , physics , quantum mechanics , ecology , biology
This article examines the relationship between medicine and the aviamento , a system of debt‐peonage that structured exchange along the Brazilian Amazon during the nineteenth and twentieth centuries. Under the aviamento , merchant elites leveraged control over health resources to broker an unequal exchange between generalized suffering and limited access to care. In the 1980s, health activists mobilized to overturn the aviamento's care regime and institutionalize health care as a universal right and state obligation. Despite subsequent growth in medical infrastructure, interviews with contemporary health‐seekers demonstrate the public system's increasing susceptibility to private appropriation, as well as the limitations of biopolitics as a framework for understanding medicine's relationship to power under the COVID‐19 pandemic. Rather than a diffuse instrument of social control, medicine is conceptualized here as a perpetual interchange, one in which brokers’ ability to direct health‐seekers' pathways from affliction to cure situates day‐to‐day health struggles within a regional history of social conflict.