In October of 2014, Romanian mass-media featured the local story of a few dozen citizens—most of them Orthodox nuns—refusing their newly issued state health insurance cards, on the grounds that the term card imprinted on the card would spell, when read backwards, drac—the Romanian word for “devil.” It seemed that the nuns, along with a few Orthodox priests and monks and other laymen, rejected the cards because they saw in them instruments of population control imbued with malefic powers. In their view, anyone who would accept the biometric chip-enabled health insurance card would bear the “mark of the beast,” as prophesied in the Christian Book of Revelation. “The beast” would be the computerized data system of global surveillance, whose ultimate aim is to strip humans of their God-bestowed freedom.

Upon reading this news, I was not necessarily astonished by the fact that a narrow demographic group would express such apocalyptically articulated anxieties when facing the biopolitical regimes of health care provision. In Romania, as elsewhere, fundamentalist Orthodox websites disavow various biomedical procedures—like vaccination—on similar grounds, by equating them with receiving “the mark” and by evoking the millennialist opening of the seals that precede the coming of the Antichrist. What did surprise me was the backwards reading of the word card as drac. Why would someone read anything backwards? And how does one get the idea of reading in reverse in the first place?

I took my own health insurance card in my hands and tried to read it the way the Orthodox nuns might have read theirs. And all of a sudden I was struck by its materiality. While staring at the card, my mind stopped conjuring the entitlements to medical services that it granted. I am unsure if the mental process I underwent qualifies for the status of phenomenological reduction, but I was simply contemplating the rectangular piece of plastic in my hands. My consciousness was ensnared by the card’s material presence, while all my background knowledge about health care and medical insurance was suspended. As a pure object of the phenomenal world, the card had lost its strict spatial attributes and had no up and down, left and right, recto and verso anymore. It had become a polymorph and dynamic thing that I kept rotating slowly between my fingers, until, indeed, “the devil” popped up.

That the nuns had most likely contemplated rather than just embraced the health insurance card seems to make sense when thinking about the fact that they are presumably living in a lifeworld imbued with signs of decay that reveal the coming of the Antichrist. Uncovering the materiality of the health insurance card is a form of taking possession of the card, while questioning at the same time the promise of health care benefits that it bears. In contrast, accepting the card for what it is claimed it represents and completely bypassing its materiality would be letting the world of medical insurance and health care services take over you. By operating a contemplative scrutiny of the actual objects that make access to health care possible the nuns rightfully diagnosed the violence encapsulated in the state-driven system of medical insurance.

We might similarly grasp something of the complicated dynamic of desire and resistance in relation to medical care claims, entitlements, and benefits when allowing our gaze to engage with the materiality of health care, as it unveils to our consciousness. At the 2015 AAA in Denver, Julian Chehirian, a student at American University, who is researching the social history of psychiatry in communist Bulgaria presented a paper about his Excavating the Psyche exhibition —a display of a psychiatric consultation room. In order to really wrap our heads around the already shopworn idea that psychiatry was used as an instrument of political repression, Chehirian invited us to contemplate actual objects, such as the medicine cabinet. The “true force of things”—as Sahlins (1981) once said in reference to what symbols represent—resides in the disquieting presence of the tall and narrow cabinet, with its glass door that reveals and protects its content at the same time. Neatly arranged syringes, small medicine bottles, ampoules, and prescriptions convey order and terror. The order of terror. The severity and the coldness of the cabinet white-painted metallic frame gives the viewer an uncomfortable bodily frisson.

Recently, my gaze was captured by a similar white metal hospital item—the nightstand. I am referring to the type of nightstand that is still common in most Romanian public hospitals. Sometimes, its metallic drawers are pastel-colored in shades of pale pink or faint blue, but—white or pastel—the paint is always chipped on the edges. The hospital nightstand is a liminal object where ambiguities converge. It is a familiar piece of furniture that we know from home, yet it appears so foreign and anonymous in a hospital setting. It divides a patient’s vital space from that of the nearby roommate, but it also connects the individual patients’ personal spaces. It is a functional object whose empty ugliness mobilizes patients, family members, and even medical practitioners sometimes, to tame it and to make it look less like a painful metaphor of the current state of public medical care in Romania.

In a quintessential act of engagement with the materiality of health care, the ritual of domesticating the hospital nightstand starts with drudgingly opening its semi-stuck drawers and covering their rusty bottom with wrapping paper or roll paper brought from home for this specific purpose. Once the drawer is padded, various personal items are placed inside: silverware, plates, cosmetics, towels, and the phone charger. And toilet paper. A nice chocolate box or a bag of coffee for “the gifts” to the doctor and nurses might find their place inside the nightstand as well. Also, a few empty envelopes—in case “the gift” takes a monetary form. Then, the top of the nightstand also gets covered with roll paper, a decorative kitchen towel, or even a small macramé tablecloth. Various items show up on the nightstand—medication, a mug or a glass, a phone, books and magazines, writing utensils, bottled water, and a vase with flowers. Sometimes, a small icon. It is tempting to read patients’ socio-economic profile and personal history through a reading of their customized hospital nightstand. Moreover, by contemplating the hospital nightstand, a trained eye can decode a patient’s diagnosis, the projected length of stay, and maybe even the prognosis.

However, I am mostly interested in the materiality of the hospital nightstand for its potential in exposing the regimes of health care delivery. The nightstand is not only the tangible expression of patients’ past experiences within the realm of state medicine, but also of their expectations and assumptions regarding medical entitlements and benefits. How does the inventory of patient items placed on or inside the nightstand correlate with the quality of hospital services or with the resourcefulness of the system of medical care more generally? Without really addressing such a question or similar ones, Healy et al. (2015) explore the use of nightstands (and over-the-bed tables) and provide interesting data on the kind of items that patients surround themselves with in a rehabilitation hospital in the US. Making a similar inventory in a Romanian hospital would be a starting point for a deeper analysis.

Finally, I would like to consider the hospital bag, as another example of the way citizens attempt to tame their anxieties about the transforming landscapes of medical claims and entitlements in a post-socialist context, by acting upon the materiality of care. Before being an actual bag, the hospital bag is just a checklist of things that an expectant mother packs in preparation of her hospital birth. The internet abounds in video tutorials, advising websites, and chatrooms dedicated to its content. With the hospital bag, the materiality of health care shifts back and forth between the actual experience of giving birth in a maternity clinic and the virtual anticipation of such an event. When looking for online information or asking their peers about what to pack for their upcoming hospital births, future mothers have to face their most terrifying assumptions about the low-quality provision of reproductive care, while mobilizing their most hopeful emotions. Packing the proper hospital bag is a strategy to navigate perceived reproductive vulnerability.

Beyond embodying personal reproductive experiences, the hospital bag can also offer a reading of how people position themselves in relation to the various regimes of medical care distribution. The interminable list of items presumably needed to give birth in a Romanian state maternity hospital includes everything from toilet paper, cotton, diapers, onesies, blankets, and baby wipes to breast pumps and silicone nipple shields, etc. By contrast, those who can afford the expensive care of private birthing clinics boast about their minimalist hospital bag—allegedly containing only a tooth-brush and the bank-card. It seems that not having to deal with the materiality of health care is a consequence of having access to forms of privileged care. The women whose hospital bag is a card have no reason to engage with its materiality as a pure object of the phenomenal world. Their card will always spell an unequivocal card.

In the end, the musings that the contemplation of actual items of health care provision engender—from the overwhelming materiality of the health insurance card, to the anguish-producing hospital furniture and the material volatility of the hospital bag—are in fact about structural violence, biopolitical surveillance, uneven access to medical care and reproductive vulnerability. Yet, as I have sought to show within this brief piece, engaging with the materiality of health care genuinely empowers patients in their attempts to co-produce the emergent meanings of reformed medicine.

 

Cristina A. Pop earned a PhD in Linguistics from Babeș-Bolyai University (Romania) and a PhD in Cultural/Medical Anthropology from Tulane University. Her work scrutinizes the transformations in women’s sexual and reproductive health produced by the post-socialist restructuring of medical care in Romania. Cristina has published articles in Medical Anthropology Quarterly and Culture, Health and Sexuality. She is currently preparing a book manuscript about the Romanian cervical cancer “epidemic.”

 

References

Sahlins, M. 1981. Historical Metaphors and Mythical Realities: Structure in the Early History of the Sandwich Islands Kingdom. Ann Arbor: University of Michigan Press.

Healy, S., Manganelli, J., Rosopa P. J., Brooks J. O. 2015. An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital. Health Environments Research & Design Journal. 8(2): 43-55.