An epidemic of end-stage kidney disease in remote Australian First Nations communities calls attention to the care practices that enable patients’ blood to flow through dialysis machines in order for it to continue to flow through their bodies. The care practices of patients, their families, health professionals, social care workers and others are essential to sustaining medical treatment, livelihoods and the ways of life of many First Nations peoples. Yet, patients’ conditions and treatment are also underscored by hidden interdependencies that result in policy effects of neglect, paternalism and oppression. These include ongoing displacement of First Nations peoples from hunter-gatherer economies, which has led to structural poverty and lifelong malnutrition among many; extractive industries on First Nations Country that can contribute to poor water quality and that in some cases fund dialysis treatment facilities; and fiscal arrangements in which regional governments are awarded federal grants on the basis of First Nations and remote-dwelling populations, yet do not fund dialysis facilities on the basis of need and displace most patients from their Country for treatment. 

This seminar explores how circular flows of care do not merely remediate or reinscribe the dynamics of extractive capitalism and settler colonialism. I attend to the role of care practices in transporting policy affordances into everyday life through ethnographic work in collaboration with Yolŋu living with kidney disease and their families, elaborating approaches to care as multivalent and morally ambiguous. I show how policy is made to work through the connective capacities of caregiving and relations of asymmetric reciprocity among patients, their families, health professionals, public housing inspectors, and others. Policy moves from strategic documents, guidelines, funding models and eligibility criteria into homes and hospital beds through care practices that enable it to acquire a range of meanings while leaving underlying tensions and contradictions unresolved. I develop an understanding of policy translation as a contested praxis of care that (re)configures relationality, interdependency and responsibility among diverse social worlds.

Dr Stefanie Puszka is a DECRA Research Fellow at ANU’s School of Medicine and Psychology. She brings together a specialisation in medical anthropology, an interest in chronic conditions and disability, and a regional focus on First Nations communities in Northern Australia. Her forthcoming book manuscript, Care Circuits: Yolŋu, kidney disease and the work of policy translation, based on her PhD dissertation, forms the basis of this seminar. She is also undertaking fieldwork to explore the care economies of the National Disability Insurance Scheme in remote First Nations communities. 

Zoom link: https://anu.zoom.us/j/82431454032?pwd=owA39nWqTYm2TGOcC0sWa9bEDVangD.1