Ill-timed patientsgitanos, cultural difference and primary health care in a time of crisis

Abstract

In this dissertation I explore the multiple meanings that cultural difference acquires in everyday practices in public primary healthcare centres in Madrid. I specifically look at how Gitano’ and Roma’ cultural difference is understood by healthcare workers in various settings at primary healthcare. Gitanos have been living for centuries in Spain and they have been historically persecuted and segregated from wider Spanish society. Current European policies aiming for “Roma inclusion” include health as one of the strategic areas of intervention. Roma and Gitanos’ health inequalities are frequently mentioned but little is known about the actual health-status of Gitanos and Roma or the difficulties they encounter when accessing healthcare facilities. Furthermore, the public healthcare system in Madrid has gone through several changes in recent years, some of them publicly contested (like various privatisation attempts, for example) others inadvertently assumed (like the budgetary cuts). Primary healthcare is the access door to the public healthcare system, but it is also a social space where broader social representations about Gitanos intertwine with different expert knowledge systems (such as biomedical or managerial knowledge) in the provision of healthcare. Drawing on twelve months fieldwork in primary healthcare centres, in this dissertation I explore how notions of cultural difference are enacted within the specific social space of primary healthcare centres, which are complex technical, moral and political sites. This dissertation engages with the debates about the complex relation of culture and biomedicine and with the anthropological literature on care to investigate the multiple uses and meanings that healthcare workers give to “cultural difference” and how and when they operationalise Gitano difference in their practices. Through the analysis of these encounters in clinical settings this dissertation sheds light on the ways that social representations of Gitanos are articulated within the institutional configurations that frame the provision of care.