The Anatomy of Ephemeral Care: Health, Hunger, and Short-Term Humanitarian Intervention in Northwest Nepal

摘要

Drawing upon two and a half years of ethnographic fieldwork conducted between 2006 through 2010, this dissertation explores the experiences, traces and (after)lives of three prominent models of short-term care---medical volunteer stints, what I call "medical voluntourism"; "health camps"; and intermittent food aid distribution programs---as they play out in the complex domain of everyday politics and unmet basic needs in Nepal's remote mountainous district of Humla.;To shed light on these phenomena, I ground this ethnography in the stories and lived experiences of Humli people seeking an end to sickness and hunger, and attending to other basic needs, amidst the fleeting forms of care that have appeared around the claims and representations of poverty and suffering made on their behalf. I map the social and political lives of medicines and food aid distributed at these ephemeral events by exploring how and why people and "aid commodities" move in and between sites of intervention and situations of need. I also examine the circulations of foreign medical volunteer programs in Humla to show how volunteers have their own social and material effects and afterlives. I look at the everyday ways that Humli people navigate these interventions in settings of chronic scarcity using creative strategies to meet their healing and eating needs, and how in turn these interventions inform local perceptions of needs, places, and possibilities. In doing so, I illuminate the paradoxical roles that these fleeting forms of care can play in both supporting and/or endangering health care delivery and humanitarian efforts to address hunger in war-torn and post-conflict environments, and how short-term forms of care run largely by foreign actors and institutions often comprise a powerful nongovernmental government that shapes and constrains local aspirations and hopes for improved livelihoods. To this end, I advance three central arguments.;First, I propose that the presence and practices of short-term medical volunteers in Humla contribute to reconfiguring local ideas about health, medicine, and wellbeing. Second, I propose that the medicines and food aid obtained at health camps and food aid programs---which, in this dissertation, I refer to as aid commodities---come to have meaning, value, and uses that both relate to and extend beyond those immediately associated with medical treatment and food shortages during times of war and post-conflict. Third, I propose that while health camps and food aid programs fill a need here and there, they obscure the historical and structural reasons why Humli people experience sickness and hunger, and ultimately that these interventions contribute to the medicalization of unmet basic needs by partitioning out through discrete interventions the inextricable experiences and pursuits of health, hunger, and wellbeing.;Exploring why Nepali people seek out medical volunteers, and attend or do not attend health camps and food aid programs forces us to expand our understanding of the landscapes in which people seek relief from sickness, hunger, and suffering. It also challenges us to broaden our conceptualization of the lived experience of health, hunger, and wellbeing while also critically examining and weighing the possibilities and limits of `doing good' through prevailing short-term models of care.