Enveloped Lives is an ethnography that uses the lens of the informal payments given to healthcare workers across the eastern bloc to understand the intersections of socialist, post-socialist, and neoliberal political economies in practice today. Set in the Lithuanian medical environment, Rima Praspaliauskiene examines a number of themes including the ethics of healthcare, the politics of care at both the institutional and personal levels, and even the future of healthcare. The author begins with her own experiences as a child in Lithuania and continues to weave ethnographic evidence through the book to perfectly illustrate the range of complexities surrounding giving and receiving “envelopes.” Praspaliauskiene presents various perspectives from patients and caregivers demonstrating how this ubiquitous practice is contested.
Praspaliauskiene uses the ethnographic technique of tracing the relations between objects, in this case the envelope or other forms of gifts given to or received by healthcare workers. Over eighteen months of fieldwork spanning from 2012 to 2017, the author conducted participant observation and interviews in a hospital in Vilnius, as well as archival research to trace the role of informal payments in healthcare reform. Along the way, Praspaliauskiene collected “canonical tales” and other stories that used “envelopes” as illustrative of life during Soviet communism. These stories are shared as interludes between chapters and add texture to the broader analysis.
Chapter 1 focuses on the ethics of payments and transparency. Anti-corruption movements aim to shift money given informally to more transparent co-payments. Discourse around transparency represents the historical shift from Soviet to European, a new stage of modernity. However, the value of the envelope exceeds the market value of the physical payment. Praspaliauskiene illustrates how individuals see the payments as relational and why reform in this area meets such resistance. She uses three lenses: the history of Lithuanian healthcare during socialism; post-socialist healthcare reform projects; and, the connection between the rise of private healthcare and the movement to stop informal payments.
Praspaliauskiene continues to emphasize the symbolism of envelopes in Ch. 2. She explores how the envelopes have been integrated into perceptions of the quality of care and that they are an expected part of the patient-practitioner encounter. The author calls this “being caught” in the envelope, when all medical interactions are interpreted through the lens of the envelope. This practice has a mythical origin and is both mandatory and not. The author demonstrates how the envelopes have become part of the healing process, the framework through which patients measure the quality of care they receive and the prognosis of their recovery, taking on a placebo effect.
The role of healthcare providers is the theme for Ch. 3. How physicians learn to negotiate encounters with envelopes, both as care givers and family members of patients, is an important part of developing their personal ethics as healthcare providers. Here, Praspaliauskiene expands on the differences between payments, gifts and bribes and the commodification of care. Using interview data about how and when physicians accept envelopes, she illustrates the complexities that physicians feel being caught between responsibilities as healthcare providers and members of their community. From the doctor's perspective, envelopes both challenge their authority and recognize them as good professionals.
In the final chapter, the author discusses her concept of “caring collectives,” or the relationships, kinship, and interdependency that connect families and neighbors with healthcare providers. Necessary for survival in times of strife, economic or otherwise, these collectives are still a way of receiving affordable and personalized care. Envelopes help build the relationship between patient and practitioner, humanizing the care received in an increasingly “technocratic and neoliberal” environment (117). Important to note is that these collectives are transient assemblages and set in motion upon need.
This book addresses a question scholars working in the former eastern bloc have been asking for over twenty years—when will post-socialism end? The answer is clearly “not yet,” based on the lived experiences presented in this book. Additionally, this book could hold a wider appeal. Praspaliauskiene draws on a variety of theories, not only related to post-socialism or anthropology, to present an analysis of economics, gifts, healthcare, and even community. The author presents concepts clearly but with complexity, which means specific expertise is not required, making this book an excellent read for undergraduates through experts in these fields.
