Health Care on the Border: Professional Caregiving, Universal Health Security, and Tuberculosis Control in Thailand and Its Border With Myanmar

Abstract

This dissertation is an ethnography of caregiving and bureaucracy. It examines professionals’ practice of caregiving in the context of the two global health movements—the expansion of universal health coverage (UHC) and the “eradication” of tuberculosis (TB)—in Thailand, a global model of UHC, and its border with Myanmar, the other TB-laden nation in which UHC is still far from being achieved. Drawing from more than eight years of experience working as a Thai medical doctor and fourteen months of fieldwork in Thailand, I explore how professionals who work in the health bureaucracies strived to ensure health security of every person regardless of national boundaries. Focusing on the domination and governmentality of market model and management rationality embedded in the two global agendas, I found that the neoliberal “iron cage” not only instills indifference and medicalization but also inhibits the achievement of the global efforts. Using ethnographic encounter to discern the intricate assemblage of global bureaucratization, I argue that “professional caregiver”—a particular subjectivity of caregivers who have institutional and moral obligations to care for others—provides the openness for the professionals’ liberation that enables them to cross the boundaries and transform the bureaucracies from within.