Suspicious bodies: anti-citizens and biomedical anarchists in South Africa’s public health care system

Abstract

It has become “common sense” to assert that access to public health care services for foreign migrants is de facto exclusionary. Conceptual tools for assessing these experiences are relatively absent and limited to “medical xenophobia.” This article deploys suspicion as a heuristic to explore the practices that health care providers in South Africa’s public health care system adopt in reading black bodies against the grain to expose their repressed or hidden meanings. It argues that the discursive construction of “outsiders” by some health care providers is based not simply on nationality, citizenship or legal status but on a vigilant preparedness for attack rooted in professional mandates to watch for possible “predators.” Such health care providers do not simply orchestrate a direct attack on migrant bodies; they also respond to the biomedical signification of individual black bodies based on a process of “creaming” that takes place at the front line of provider–patient interactions that are embedded within a wider bureaucracy of migration and health governance. In the context of a high HIV/AIDS burden, which necessitates the prioritisation of adherence and retention over anything else, anthropologists are also likely to see foreign migrants accessing services based on biomedical discourses and considerations.