11 Valued Matter: Anthropological Insights ... 273(Esping-Anderson 1990 ), Mexico and its growing constituency of kid-
ney patients help us to see what happens when health care is reconfig-
ured and made primarily accessible via the “cash nexus”. The political
economy at the heart of this situation is not merely a feature of health-
care access, it is deeply implicated in the rise of CKD, the condition
kidney transplantation attempts to alleviate. Mexico, like other so-called
low- and middle-income countries, has been facing a marked increase
in CKD (Garcia-Garcia et al. 2010 ). This is partly attributed to the
concomitant rise in hypertension and diabetes, a cluster of chronic
conditions which have been intensifying in the context of a deregu-
lated economy, environmental degradation, polluted water supplies and
growing lack of access to unprocessed, healthy foods (Correa-Rotter
et al. 2014 ; Ramirez-Rubio et al. 2013 ). The effects of these concerns
are inevitably and unequally distributed among Mexico’s poor and
flexibilised work-force. In contexts defined by unequal, metered access
to health care, the labour involved in what are complex attempts to
secure care on a formal level cannot be underestimated for families like
Carlos’s. That labour demands a detailed examination, is one I demon-
strate below.
It is important to emphasise, that without a synoptic view of health-
care provision or visible “topology” of transplant medicine, Mexico’s
uninsured CKD families embark on extraordinary and, in many cases,
impoverishing journeys to access care. The labour involved includes,
among many other things, not only the need to secure relevant renal
replacement therapy but, in many cases, appropriate and timely diagno-
ses. For many patients, diagnosis occurs when their kidneys are already
in the end stages of functioning, often after a litany of misdiagnoses.
By whichever route patients come to be diagnosed, what is common
to all is the effort required to identify and access complex regimes of
care. This can involve sourcing medications, via Mexico’s expansive and
growing system of private pharmacies, the labyrinth of black market
street sellers for close-to or beyond sell-by-date medications, acquiring
samples from pharmacies, medical staff and drug companies, informal
medication-exchanges with other patients, often facilitated by patient
associations, charities, doctors or serendipitous encounters. Attempts
to access modes of dialysis as well as routine tests and examinations,
http://www.ebook3000.com