title: Narrating health and scarcity: Guyanese healthcare workers, development reformers, and sacrifice as solution from socialist to neoliberal governance.
abstract: In oral history interviews, Guyanese healthcare workers emphasize continuity in public health governance throughout the late twentieth century, despite major shifts in broader systems of governance during this period. I argue that these healthcare workers' recollections reflect long-term scarcities and the discourses through which both socialist politicians and neoliberal reformers have narrated them. I highlight the striking similarities in discourses of responsibility and efficiency advanced by socialist politicians in 1970s Guyana and by World Bank representatives designing the country's market transition in the late 1980s, and the ways these discourses have played out in Guyana's health system. Across diverging ideologies, politicians and administrators have promoted severe cost-control as the means to a more prosperous future, presenting short-term pains as necessary to creating new, better, leaner ways of life. In the health sector this has been enacted through a focus on self-help, and on nutrition as a tool available without funds dedicated for pharmaceuticals, advanced medical technologies, or a fully staffed public health system. I argue that across these periods Guyanese citizens have been offered a very similar recipe of ongoing sacrifice. I base my analysis on oral histories with forty-six healthcare workers conducted between 2013 and 2015 in Guyana in Regions 3, 4, 5, 9, and 10, as well as written records from World Bank and Guyanese national archives; I analyze official discourses as well as recollections and experiences of public health governance by those working in Guyana's health system.
authors.affiliation: Department of Science and Technology Studies, Cornell University, United States. Electronic address: akw45@cornell.edu.
authors.forename: Alexis
authors.initials: A
authors.lastname: Walker
mesh_terms: D001291:Attitude of Health Personnel; D006172:Guyana; D018166:Health Care Reform / Q000379:methods* / Q000639:trends; D006282:Health Personnel / Q000523:psychology* / Q000639:trends; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D033262:Narration; D036301:Qualitative Research; D012456:Salaries and Fringe Benefits / Q000639:trends; D012950:Socialism / Q000191:economics / Q000639:trends; D019472:Universal Health Insurance / Q000592:standards
keywords: Caribbean; Efficiency; Guyana; Nationalism; Responsibility; Socialism; Structural adjustment