In remote Indigenous communities, people with end stage kidney disease have limited access to dialysis services and the vast majority of patients contend with urban displacement in order to access treatment. Through ethnographic encounters with Yolŋu renal patients and other actors in Northern Territory healthcare systems, this paper explores how the threats posed by end stage kidney disease are multiply conceptualised and imbued with different forms of moral and political value. Drawing on Mary Douglas’ cultural theory of risk, I consider how Yolŋu, health professionals and health policymakers construct topographies of safety and danger. I argue that medical risk is deployed in Northern Territory healthcare systems to perform the ‘dirty work’ of governing uncertainties and threats to renal patients’ health and of distributing treatment amongst patients and over space. The ‘dirty work’ of medical risk recasts questions of value and the distribution of resources into matters of safety and liability.

中文翻译：

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北领地肾脏服务风险的“肮脏工作”

在偏远的土著社区，患有晚期肾脏疾病的人获得透析服务的机会有限，并且绝大多数患者为了获得治疗而与城市流离失所作斗争。通过与北部地区医疗系统的约卢族肾病患者和其他行为者的人种学交流，本文探讨了末期肾脏疾病所构成的威胁如何在概念上得到多重化并赋予不同形式的道德和政治价值。借鉴玛丽·道格拉斯（Mary Douglas）的风险文化理论，我考虑了约鲁ŋ（Yolŋu），卫生专业人员和卫生政策制定者如何构建安全和危险地形。我认为，在北领地医疗保健系统中部署了医疗风险，以执行“肮脏的工作”，以控制不确定性和对肾病患者健康的威胁，并在患者之间和整个空间范围内分配治疗。医疗风险的“肮脏工作”将价值和资源分配问题重塑为安全和责任问题。