4 ‘Bleeding antibiotics’: negotiating care and trust in Turkish healthcare infrastructures

Abstract

Antibiotic prescriptions make up a quarter of all prescriptions in Turkey These locally ‘ordinary’ pharmaceutical commodities are used as tokens of care, enablers of treatment and legitimisers of illness to navigate in everyday healthcare infrastructures Patients express embodied experiences of antibiotics circulating in their blood stream to reveal the abundance of antibiotic use in their medical histories Yet access to antibiotics is becoming increasingly regulated, which is necessitating negotiations of care and trust amongst patient, doctors and pharmacists Antibiotics, which for a long time have been reliable and easily accessible objects of care, are now proving less effective as treatment With the growing concern of antimicrobial resistance (AMR), the over-the-counter sales of antibiotics have stopped in Turkey since 2015 Which means that antibiotics are only legally available through a doctor’s prescription Moreover, the COVID-19 pandemic has recently limited doctor consultations, further restricting access to prescription medication This paper explores the implications of the recent regulations and AMR on prescription practices, patient experiences and patient-doctor relationships within antibiotic infrastructures The research draws on a three-month ethnographic fieldwork in Istanbul, Turkey, to understand negotiations of care and trust in processes of prescribing and acquiring antibiotics during the COVID-19 pandemic The theoretical framework of the research is rooted in medical anthropology Drawing on qualitative interviews with doctors, pharmacists and patients, as well as participant observation in an unfolding pandemic, this study shows that antibiotic prescription processes are becoming embedded in negotiations between patients, doctors and pharmacists Moreover, despair amidst tension and uncertainty is increasing the contingency of navigating care and trust in the healthcare system to enable alternative ways of access to antibiotics