Moral economies of kidney disease and care: Interdependencies between Yolngu and the Australian state

Abstract

My thesis analyses the social, economic and political relations of care that arise through end stage kidney disease in an Australian Indigenous society. An epidemic of end stage kidney disease amongst Indigenous Australians, and poor access to life-sustaining dialysis treatment in remote communities, sees healthcare for patients from remote areas administered through urban displacement. I consider how the care for Yolngu renal patients is practiced and valued in Yolngu families and in health and social policy. I explore how the multiple values and practices of care for Yolngu renal patients in Yolngu families and in health and social policy interact; and the implications for relations between Yolngu and the state. In this thesis I bring together the scholarship of care, the anthropology of Indigenous economy and classic gift theory in a novel way. I adopt an ethnographic approach grounded in renal patients' and carers' narratives, while also incorporating service provider and policymaker perspectives. I begin by exploring the social suffering produced by kidney disease and the relations and practices of domestic care in the families of Yolngu renal patients, describing a Yolngu ethics of care. I show that care-giving is understood by Yolngu as investing value in people, relationships, family solidarity and material equality. Giving and receiving care is understood by Yolngu primarily as a relationship between generations, and may provide a means of exercising power and responsibility within gendered and age-based social roles. Care is enacted through interlocking material and non-material reciprocities in Yolngu domestic moral economies. I go on to explore how Yolngu attempt to realise a Yolngu ethics of care through healthcare, social housing and social security payments. I show that while some of the care needs of renal patients are recognised in health and social policy, the everyday subsistence struggles of their carers and other kin are often neglected in public policy embodying neoliberal values of self care, self sufficiency and responsibilisation. My research reveals how the neoliberal state relies on social relations and care practices in Yolngu families, constituted through fundamentally different values, to realise health and social policy agendas. Yolngu care practices such as performing domestic labour rather than working in the formal economy, sharing, extending shelter to kin, and hunting and gathering are mobilised yet marginalised by the neoliberal state. Neoliberal values of care are parasitic on social roles within families and in some cases may strain relations among kin, reproducing bodily, social and economic precarity. By considering the intertwining of material and non-material dimensions of care, my thesis challenges received ideas about Indigenous dependency on state welfare. I show that an interdependent but unequal relationship exists between Yolngu families and the state, through health and social policy agendas, in satisfying the basic needs of life of Yolngu renal patients and their kin. Such interdependencies become particularly salient in times of post-universal, conditional healthcare and welfare. In some circumstances, they also provide a means by which Yolngu may exercise power and gain recognition from the state. Show more