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Accepted Paper:
The care blind spot: Mexican policies for Chagas disease
Mariela Sánchez-Belmont Montiel
(The University of Manchester)
The paper examines how the design and implementation of the policies to care for and prevent Chagas Disease in Mexico are designed to care for the patients but have blind spots where neglect is (re)produced.
Paper Abstract:
Chagas Disease has long been included in the WHO list of Neglected Tropical Diseases. However, what does it mean for a disease to be neglected, in practice? Who is doing the neglect, and how?
This paper takes the case of Chagas Disease in the Mexican health system to examine the role of the national state in producing one of the ways in which the disease is neglected: through policy design and implementation. After 12 months of fieldwork within the Mexican national health secretariat, this research explores how a policy that aims to deliver care -and, to an extent, does-, also produces the blind spots through which neglect is produced and reinforced: cases that fall through the cracks, epidemiological reports that veil realities on the ground, and manuals that are not fit for purpose. The paper explores some of the historical and geopolitical elements that have played a role in this policy design such as the close involvement and collaboration with international organisms (i.e. WHO/PAHO), neoliberal trends of decentralisation of public services in the 1990s, and a modern push for systems of accountability and evidence-based decision-making. The paper finishes with a reflection around the role that Medical Anthropology could have in understanding health policies as lived processes rather than flat documents, with the aim of closing some of the gaps that are created by a public health ecosystem that favours fragmentation.