Politics and Inequality in Pain Management: The Case of Zimbabwe

My proposed research addresses the politics of pain and its management in Zimbabwe, as a window onto social inequalities. Pain cuts across divides - it affects us all, and is in this sense a powerful equaliser, but access to clinical pain management is uneven. Of the 298.5 metric tonnes of morphine equivalent opioids produced globally each year, on average only 0.1 metric tonnes go to low-income countries. While clinical pain management is lacking, many developing countries are also experiencing a steady increase in opioid use disorder (OUD). Patterns of opioid use reflect inequalities in socio-economic opportunity; access to clinical care; judgements about acceptable standards of living and levels of discomfort; and racialised discourses about pain tolerance. This is an issue calling for interdisciplinary analysis that has been largely overlooked in social science circles. Zimbabwe's colonial history, decades of related political and economic volatility, and a double burden of HIV/AIDS and cancer have shaped a unique landscape of pain. Today, the country faces a significant lack of clinical pain management and a rise in illicit opioid use. My proposed research will explore these phenomena as a window onto the politics and inequalities of pain management, and the social life of medicine both nationally and globally. I will address two overlapping questions: how do social inequalities shape the distribution of pain, and condition the circumstances of its management? And what is the subjective experience of pain management, both for those who suffer and those who provide care? My research will thus address pain and its management as expressions of social and political processes - as a dimension of Zimbabwe's wider 'crisis', shaped by dynamics that span geographies and timeframes. This approach will be grounded empirically, beginning with the collection of data on the distribution of pain and the circumstances of its management. This will then inform qualitative interviews and participant observation to be carried out during fieldwork in the second year of the DPhil, illustrating how pain and its management are interpreted and experienced on a human level. A post-colonial state experiencing the aftershocks of a string of related crises, Zimbabwe is a powerful prism for understanding how patterns of pain and opioid use highlight a wider politics of inequality. My research will ultimately seek to illustrate the embodied experiences of these phenomena, and from this perspective inform more equitable and sensitive systems of analgesia.