Tinkered care: Assembling Medicine Consumption in Grey Zones

Abstract: The aim of this dissertation is to advance knowledge about care as situated practices within and beyond medical institutional settings. It addresses the phenomenon of substandard and falsified medical products, an issue that concerns state governments globally and organisations including the World Health Organization. While legal sanctions and technological innovation are strongly advocated to protect legal pharmaceutical markets, this study looks at ambivalences and ambiguities in the provision and experiences of health services. By drawing on the concepts of assembling and tinkering, and using empirical data collected from care seekers, physicians and pharmacy staff, the analysis suggests that the individual agency of care seekers is enacted and enabled in a context where an ability to adapt to a changing environment increasingly becomes a social norm. Medical professionals are well aware of people’s evolving medicine consumption, but find it challenging to respond to these changes. Furthermore, observations conducted at pharmacies suggest that, in this semi-institutional and semi-retail setting, medical authority is carefully managed through embodied and routinised engagement with store environments and by attuning to customers’ emotions. All these findings lead to a conceptualisation of care as a tinkered practice, with attentiveness and flexibility being two essential characteristics. However, tinkered care involves risks, especially in relation to medicine access and use.Tinkered care: Assembling medicine consumption in grey zones provides an empirical account of health services as a multi-actor network. It adds knowledge to the spatial-temporal dimension of care practices and offers a conceptualisation of care as tinkered practices. It argues for a need for alternative understandings of care and health services other than institutionally scripted ones.