Productive Pathologies: Professional Patients and the Commodification of Disease in Egypt

• Applicant: Professor Dr. Hansjörg Dilger, Ph.D.
• Subject Area: Social and Cultural Anthropology and Ethnology
• Term: from 2015 to 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 272716263

This project examines the growing phenomenon of ‘professional patients’ in Egyptian society. It traces patients’ disease commodification and involvement in bedside teaching and evaluation scenarios. It shows how, with increasing poverty and unemployment, some patients find a biovalue in their diseases and market knowledge about them in medical schools. The findings of the first research phase demonstrate that engaging in a disease business assists patients to have access to social and economic capital, which is inaccessible otherwise. It highlights that patients’ commodification of disease is a tool not only to restore their social position, but to manage the disease itself.In particular, the research shows that: 1) medical ethics are ignored by medical professionals, at a time when patients are not aware of them. At the same time, to meet their career goals, medical assistants are compelled to cooperate with professional patients to satisfy their seniors’ needs to demonstrate to their students. 2) This phenomenon is a result of structural violence in medical institutions that do not cater to the needs of the patients and accordingly ordinary patients are turned uncooperative in teaching hospitals, which leads to the flourishing of a “disease market.” In the conditions of disease commodification, disease is turned into a savior and a companion that helps patients manage the disease itself. Social wellbeing in this case overweighs physical wellbeing. 3) Commodifying disease empowers patients and helps them to become independents, to survive poverty and to take over responsibility for their families. Still it is considered stigmatizing and needs to be navigated carefully. While some male patients tend to conceal their disease activities, female patients reveal them and recruit fellow neighbors to protect their reputation. 4) Biosocialities emerge of such “disease work,” which are based on learning strategies to market disease and live with it. They also provide a sense of security and a community to their members.Building on these findings, the next phase of research will investigate disease as a form of “everyday resistance” (Scott 1985) where gender plays a vital role. In this regard, patients are involved in a subtle silent movement to claim rights in front of the state and to restore their position within the family, whether empowered or subordinate. By focusing particularly on the dynamics of gender, we propose to investigate how: 1) women engage in this disease work to inflict shame on their kin who neglect and abandon them after a divorce or the death of a husband by adopting a disease identity. 2) Men engage in a silent resistance to state’s neglect by claiming the ‘right to service’ in medical institutions by commodifying their diseases while accessing medical service inaccessible otherwise.

• DFG Programme: Research Grants