Examine The Republic Of Therapy: Triage And Sovereignty In West Africas Time Of AIDS (Body, Commodity, Text) Articulated By Vinh-Kim Nguyen Presented In Ebook

Republic of Therapy tells the story of the global response to the HIV epidemic from the perspective of community organizers, activists, and people living with HIV in West Africa.
Drawing on his experiences as a physician and anthropologist in Burkina Faso and Côte dIvoire, VinhKim Nguyen focuses on the period between, when effective antiretroviral treatments for HIV were discovered, and, when the global health community acknowledged a right to treatment, making the drugs more available.
During the intervening years, when antiretrovirals were scarce in Africa, triage decisions were made determining who would receive lifesaving treatment.
Nguyen explains how those decisions altered social relations in West Africa, In, anxious to “break the silence” and “put a face to the epidemic,” international agencies unwittingly created a market in which stories about being HIV positive could be bartered for access to limited medical resources.
Being able to talk about oneself became a matter of life or death, Tracing the cultural and political logic of triage back to colonial classification systems, Nguyen shows how it persists in contemporary attempts to design, fund, and implement mass treatment programs in the developing world.
He argues that as an enactment of decisions about who may live, triage constitutes a partial, mobile form of sovereignty: what might be called therapeutic sovereignty.
Incredibly insightful, valuable in the way that it illuminates the necessity of appropriate health initiatives and the detriment of assuming all public health programs are equally as efficient crossculturally Not a thrilling read by any means, but informative.


Nguyen's work tackles a difficult history, and questions which are hard to accept, When most of us think of the concept of triage, we think about emergency cases being briefly examined and weighted for priority, but we think of patients who will, one way or another, receive treatment.
And who would argue that such choices have to be made, when a gunshot is clearly more urgent than a broken wrist, and a heart attack more urgent than a stomach virus But this manuscript is a painful reminder that triage can mean quite a bit more, and reference situations where it's not a matter of deciding what order treatment takes, but of deciding who receives any treatment at all, or whether some treatment for many is better than complete treatment for a few.


Examining the HIV/AIDS epidemic in West Africa, Nguyen's work offers case studies and analysis of what occurred when treatment was nowhere near available for all of those patients who needed it, and where triage meant deciding who lived and who died.
Beyond these difficult discussions, though, the most powerful parts of the book take on questions of how community organizers and victims of HIV acted on behalf of particular stories, narratives, and victims, working to affect choices of triage and so benefit not just particular people, but specific organizations and funding opportunities.
The fact that being able to speak one's story, and offer testimony of one's being affected by HIV/AIDS, was itself a factor in whether or not one might be treated at all is a hard fact to accept, much as it might make sense in the larger scheme of things.
But even beyond this point, there's then the fact that such divisions had direct bearing on relationships, Where funding, treatment, and resources are limited, those who receive any of the above are set apart from their peers, so that triage affecting treatment in fact affects a great deal more than who lives and who dies, painful even as that fact alone may be.


Although Nguyen's work is extremely academic in nature, and not an easy read, it does tackle difficult territory and questions, and offer indepth discussions related to choices of triage and treatment in the history of HIV/AIDS in West Africa.
It's no an easy read, and not particularly readable in all truth, but it is an important discussion with a direct view, and wellresearched.
The tone and the style do get in the way of a reader's easy engagement with the text, but readers who are interested in the subject will still find the book to be worth their time.
Vinh Kim Nguyen is a practicing HIV and emergency physician in Montréal, an associate professor in the Department of Social and Preventive Medicine at the Université de Montréal, and the author, with Margaret Lock, of An Anthropology of Biomedicine.
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