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UCSF UC San Francisco Electronic Theses and Dissertations UCSF UC San Francisco Electronic Theses and Dissertations Title Producing Equality: Citizenship, Science, and Medicine in the Negev/Naqab Permalink https://escholarship.org/uc/item/18t8p18h Author Razon, Na'amah Publication Date 2013 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California PRODUCING EQUALITY: CITIZENSHIP, SCIENCE, AND MEDICINE IN THE NEGEV/NAQAB by Na'amahRazon DISSERTATION Submitted in partial satisfaction ofthe requirements for the degree of DOCTOR OFPHILOSOPHY in Medical Anthropology in the GRADUATE DIVISION ofthe UNIVERSITY OF CALIFORNIA, SAN FRANCISCO AND UNIVERSITY OF CALIFORNIA, BERKELEY Copyright (2013) By Na’amah Razon ii For Nechama (Nelly) Klainer (1925-2011) And Um Raed Two sages who have taught me most about family, tenacity, and wit iii Abstract Producing Equality: Citizenship, Science, and Medicine in the Negev/Naqab Na’amah Razon In 1994 Israel passed the National Health Insurance Law (NHIL), guaranteeing universal and equal healthcare services to all citizens. Universal healthcare, while unprecedented in Israel, did not have a significant impact on the country’s Jewish majority. Yet for minority citizens such as the Bedouin community in the southern Israel, the NHIL transformed access to medical services, increasing insurance coverage from 60% to 100%, and changing the patient demographic in the regional hospital. Nonetheless, since 1995 when the law was implemented, disparities in health outcomes between Jewish and Arab citizens in the country have widened. Healthcare reform took place within a geo-political landscape that continues to marginalize its Arab citizens. Thus the paradigm of equality of healthcare intersects with national policies that create a differential citizenship in Israel. This dissertation, Producing Equality: Citizenship, Science, and Medicine in the Negev/Naqab, examines the impact of Israel’s National Health Insurance Law as a site to understand how Israel’s policies of inclusion and exclusion of Bedouin Arab citizens become entangled. My work highlights the tensions that exist between expansive and technical medical care that the state allocates to its Bedouin citizens, and the limited financial and political support the Bedouin community receives from the government in other spheres. Healthcare in southern Israel provides an important site to study the active production of the boundaries of citizenship, medicine, and reconfiguring of discrimination. I argue that the emphasis on scientific discourse in the medical arena ignores the social and political problems that iv place much of the Bedouin community in poor health. Therefore social, political, and historical questions that are central to understanding health disparities in the region remain beyond the scope of what providers view as relevant to their work. This bounding of medical care allows for the continuation of discriminatory policies towards the Bedouin citizens, while permitting the state and healthcare providers to assert they provide equal care to all patients. v Acknowledgements The individuals who most influenced my understanding of medicine and citizenship in the Negev/Naqab I cannot thank publicly and yet deserve the most acknowledgment and gratitude. These are the nurses, doctors, social workers, administrative staff, volunteers, families, and patients in Southern Hospital who shared with me their experience of seeking and providing medical care. Their insights have influenced not only this work, but my understanding of being a provider and a patient. They have pushed me to interrogate the challenges of providing equal medical care in a setting of profound inequality, and to rethink how evidence based medicine, biomedical technologies, and routine medical care remain saturated with histories of military rule, of marginalization, of segregation. My deepest gratitude goes to my committee. My chair, Sharon Kaufman, has read and commented on multiple versions of this dissertation. Her dedication to students, her insistence on clarity, and her profound understanding of the importance of anthropological research within medicine have been crucial throughout the research and writing phases. Ian Whitmarsh chaired my orals committee and helped ensure that I continue to grapple with the challenges of writing, research, and the ambiguity of both. His generous readings often helped clarify my own thinking, and he drew connections to works and themes I often failed to see. Charles Briggs’ immense knowledge of language and health disparities profoundly shaped my thinking about the intersection of public and vulnerable populations. His comments on an earlier version of the thesis helped sharpen the analytical arguments throughout. Lochlanne Jain continues to be a model of how writing and theory contributes to addressing critical questions of health and science. vi Beyond my committee, several faculty members significantly supported me throughout this project. Deborah Gordon was my first adviser in this project and has continued to be a dear friend and mentor. Nir Avieli saw the kernel of this project and of my identity as an anthropologist as an undergraduate. He adopted me into his department in Beer Sheva upon each of my arrivals. Our meetings helped orient my fieldwork and his support has been crucial to help me continue in moments of uncertainty. Nadav Davidovich generously welcomed me to Beer Sheva and provided incredibly knowledge of history, the Israeli healthcare system, and politics. His ability to write, research, teach, remain politically active, and kind are an inspiration. Particular thanks for his help with Chapter 2 and my venturing into the archive and historical research. Oren Yiftachel and Pnina Motzafi-Haller helped me maintain an academic home while abroad. The University of California, San Francisco and the University of California, Berkeley’s Joint Program in Medical Anthropology has been an intellectual home for the past five years. I have been fortunate to be surrounded by faculty and students whose dedication to thinking critically about medicine has helped me to rethink my own assumptions about medicine and health. The curiosity and rigor embedded in the program and modeled by faculty serves as an inspiration for how to cultivate a learning environment. I had the good fortunate to meet Alissa Bernstein in my first week of graduate school, and she has become a dear friend and colleague. She has read and commented on nearly all of the chapters. Additional thanks to my colleagues at UCSF and UCB: Jerry Zee, Ruth Goldstein, Carolyn Sufrin, and Liz Carlisle. Nicole Louie has been a friend and colleague since our days managing Kairos’s kitchen. The questions we vii both think through of equality and marginalization continue to inspire our work in education and medicine. This project began as part of my studies at an MD/PhD student in the Medical Scientist Training Program. My deepest thanks goes to the program (and the three directors it has seen during my time as a student), who continue supporting anthropology graduate students. Thank you to Jana Toutolmin and Catherine Norton at the MSTP office whose support and MSTP love continues to help students make our way through this program. My medical anthropology MD/PhD colleagues have provided friendship and support throughout this long training. Scott Stonington’s energy, friendship, and positive outlook on all aspects of life are an inspiration to all. Seth Holmes perseverance opened the program to anthropology students. Seth invited me to teach “Theories of Health and Social Behavior” in the school of Public Health at Berkeley in the fall of 2011. His expertise as a teacher and commitment to maintaining links between academic research and politics have helped me continue to cultivate these ties. Rachel Niehuus has been my little sibling in the program. Her intensity, love, and honesty for all things she does continue to be a reminder of how to remain living in the present. I have been lucky to be able to count her as one of my dear friends. Thank you to my medical school colleagues: Char Carlson, Elizabeth Harrington, Vignesh Arasu, Molly Thomas, Hannah Leslie, Edwin Rodriguez, Megan Swanson, Tim Poore, and Nicole Bores who cheered me on throughout this phase of the program and helped prepare me for the next stage. Writing a dissertation can be a very lonely process. I have had the good fortunate to have many individuals involved in reading drafts and providing writing support. My writing group in Israel: Adi Inbar, Dan Kotliar, Sibylle Lustenberger, and Tamar Kaneh viii provided critical feedback on earlier drafts of several chapters. Claire Snell-Rood and I arrived to Israel during the summer of 2010 and our friendship has continued since. Her astute readings of several chapters helped strengthen my argument. Claire connected me with Jennie Doberne who since our meeting at the 2010 AAA meetings in Montreal has been a friend, colleague, and editor throughout the writing phase of this project. Karen Ross and I met during language studies in Jerusalem in 2009. She continues to be inspiration of multitasking and deadline meeting for all. I have been fortunate to work together on several papers and help connect my own work to the field work of education. Nora Gottlieb provided my first fieldwork experience in the Naqab/Negev, working together on a project for Physicians for Human Rights-Israel. She has remained a close friend, a model researcher and activist. She introduced me to
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