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Paper short abstract

This paper focuses on how Russian-speaking people in Germany with Soviet/post-Soviet backgrounds transform distrust of German healthcare into practices of preparedness and control

Paper long abstract

This paper examines the ambivalence of distrust as a form of risk management in health-related practices among Russian-speaking people in Germany with Soviet or post-Soviet backgrounds. Based on three years of ethnographic fieldwork, I show how participants limit reliance on public healthcare and assemble informal infrastructures of care that compensate for perceived gaps and generate institutional frictions. In this ethnographic case, treating distrust and mistrust as discrete categories is analytically limiting; instead, I trace how low reliance on institutions is assembled, maintained, and mobilised through informal infrastructures of care.

Participants often describe German medicine as insufficient: too slow, overly formal, inattentive, or unable to provide what they consider adequate treatment. These encounters generate a strong deficit. Even when this deficit is not systemically measurable, it is deeply felt and becomes real in its consequences. In response, participants mobilise “preparedness” practices such as stockpiling medicines, exchanging drugs and advice in online chats, sharing “life hacks”, consulting doctors online and "consulting" one another in Russian-language chats, seeking treatment abroad, and turning to alternative methods.

I argue that distrust here is neither a fixed cultural trait nor a generalised suspicion towards everything. It is situational, activated when formal pathways are experienced as unreliable or insufficient. The resulting preparedness practices help participants secure what they define as “enough” care and regain a sense of control. These practices are rational responses to uncertainty that stabilise everyday life for participants, but they can also produce unintended pressures and extra workload on healthcare services and institutional regulations.