Paper short abstract:

This paper engages with the ways in which "patienthood" is physically and discursively enacted by community health workers in Roma communities in Romania.

Paper long abstract:

Across a number of health domains, but especially when so-called "hard-to-reach" groups are concerned, the participation of communities in health care provision has become an article of faith. Taking the example of Roma health mediators (Roma women employed to act as links between their communities and the health system), I discuss how in practice community involvement may facilitate state governing of these "hard-to-reach" communities.

Following a year of participant observation of Roma health mediation, I analyse the tensions and ambivalences that arise from interactions between mediators, community members, health professionals, and local authorities.

I show how participants map concepts of "good" and "bad" patients onto Roma ethnicity. I discuss how mediators use their own Roma identity and community involvement to transform "bad patients" into "good patients." I show how community members respond by participating, resisting, negotiating, or perpetuating their positions within these classifications. While acknowledging the important contribution that this community health programme brings to accessing health care, I discuss mediators' competing role in promoting a neoliberal approach to governing Roma communities that serves state rather than community interests. By conflating Roma ethnicity with a failure to conform to "correct" forms of patienthood, mediators risk fuelling existing prejudice and racism towards Roma communities. I suggest that Roma health mediation could learn from dialogical and emancipatory approaches to participatory interventions in health, which aim for transformative encounters between parties while also fostering critical consciousness and aiming to change communities' material environment.