The Work of Pharmaceuticals in Austerity-Burdened Athens. Modes and Practices of Care in Times of Crisis

ABSTRACT Based on ethnographic fieldwork carried out in a social clinic of solidarity on the outskirts of Athens, the article explores how modes and values of care are constantly reconfigured at the intersection of an ever-expanding grassroots voluntary medical sector, the state and the household in a moment of severe economic distress. It traces the changing relations of care across these three realms where diverse modes of care have traditionally unfolded. In suggesting that pharmaceuticals have become increasingly crucial to social, economic and political relations amongst citizens who can no longer afford health care, I show how in the Athenian context, the circulation, sharing and exchanging of pharmaceuticals reinforce collective social bonds and argue that domestic modes of care (frontida) have increasingly been informed by biomedical modes of care (iatriki perithalpsi) stemming from the intermittent availability and unavailability of pharmaceutical drugs.

In the field of anthropology, incursions into the realm of the sociality of pharmaceuticals have sporadically been made (see Paxson 2004: 109;Han 2013;Pinto 2014;Ecks 2017), mainly focusing on how the pharmaceuticalisation of care is a response to and a consequence of forms of state neglect and abandonment (Garcia 2010;Biehl 2004Biehl , 2012)).Scholars in the field have argued that pharmaceuticals can also legitimise forms of disregard and violence against the most vulnerable members of families and households (Han 2012a(Han , 2012b;;Biehl 2012;Pinto 2014).Holding on to the epistemological potential of pharmaceuticals in teasing out reconfigurations of modes and practices of care, the purpose of the present article is to highlight how, in the Athenian context, the circulation, sharing and exchanging of pharmaceuticals reinforces collective social bonds and thus to ethnographically amend the hypothesis that a greater resort to pharmaceuticals contributes to the individualisation of care.As I will show, in today's Athens, pharmaceuticals represent a means of reconstituting and re-socialising care at the intersection of ever-impoverishing households and the retreating welfare state.With this in mind, I contend that, in the Greek context, the pharmaceuticalisation of care has been perceived and experienced as relational practices which encompass both the management of individual illness and the collectivisation of health care.However, the collectivisation of health care practices at the grassroots voluntary sector has grown out of traditionally domestic socialities linked to the availability and unavailabiltiy of pharmaceutical drugs.By holding on to the social lives of pharmaceuticals, I trace the changing relationship between poor healthcare infrastructure and the widespread use of pharmaceutical drugs (see, i.e. Garcia 2010;Biehl 2012;Pinto 2014) while offering an ethnographically grounded analysis of the role of pharmaceuticals in shaping practices of collective care in the grassroots voluntary sector.
This article is based on long-term ethnographic fieldwork conducted in a social clinic of solidarity (Koinonoiko Iatreio Allileggii, henceforth KIA), a grassroots medical facility located on the outskirts of Athens.Like many other grassroots initiatives that have sprung up across Athens and the rest of Greece since the onset of the 2008 economic crisis (amongst others : Henshaw 2019;Douzina Bakalaki 2017;Cabot 2016aCabot , 2016b;;Rozakou 2016;Rakopoulos 2013), the social clinic has provided medical care and medication for free (dorean) to an increasing number of citizens who can no longer afford healthcare services.
Indeed the effects of austerity policies became particularly visible in people's inability to obtain care.With implementation of three structural adjustment programmes (commonly known as memoranda, menmonia), the public healthcare sector underwent several budget cuts, which led to the merging and closing of many healthcare facilities, and cuts in pharmaceutical expenses, medical personnel and wages.During nearly a decade of economic austerity, the elderly in particular were more likely to report unmet medical needs: cuts to retirement pensions coupled with the introduction of a 25 euro fee for users of hospitals, along with difficulties in reaching services because of distance (Kentikelenis et al. 2014).
Overall, by 2014 almost half of Greek children lived below the poverty line; at the same time nearly a third of the poorest Greek households faced onerous medical expenses.The situation was further exacerbated by the progressive increases in user fees and payments for medical services and drugs (Kentikelenis et al. 2014): in 2015, 41% of Greeks were materially deprived, unable to satisfy basic needs such as medications, rent or mortgage payments, and food (OECD 2015).By the end of the year, almost three million Greeks had dropped out of the public healthcare system, which had meanwhile slowly been privatised, and increasingly linked to the private insurance system.
In a moment of dramatic medical shortages at the market level, the ultimate omen of the Greek healthcare tragedy (Kentikelenis et al. 2014), the social pharmacy attached to the KIA accumulated huge quantities of medicine that citizens from all over the southern neighbourhoods of Athens had been donating since the KIA first opened in 2010.Bags full of blisters, syrup bottles, vials and ointments were routinely left at the door of the KIA.The influx of medicine was erratic at first.At the very beginning of its operation, the KIA was able to distribute mainly painkillers, broad-spectrum antibiotics, Lexotanil (bromazepam) and other medications to treat common chronic conditions such as high-blood pressure and cholesterol.Many of the medicines donated were purchasable without prescription (choris sintaggi), and commonly stored and used at home.However, over time, different classes of medicine started to be donated and stored in the social pharmacy which, in a few years, became the main hub of free pharmaceutical provision in the southern periphery of Athens.Interestingly, the social clinic also started supplying medicine to some Athenian public hospitals which no longer received sufficient pharmaceutical supply from state institutions. 1 In light of the enormous quantity of pharmaceutical material amassed in the social clinic, I suggest that Greek citizens' capacity to donate vast amounts of medicine should be understood from a diachronic perspective whereby today's process of pharmaceutical distribution as operated by the social clinic stands in continuity with the process of pharmaceuticalisation of care which began in the 1990s.While Greeks seem to have increasingly subscribed to the neoliberal imperative of self-care through self-medication, it is in fact the gradual dismantling of the public healthcare sector that this greater availability and affordability of medicine has since then been masking.The progressive pharmaceuticalisation of care as an effective and economic mode of care first came under state-sponsored programmes, whose aim was to reduce both the inflow of people into public healthcare facilities and the population's dependence on public healthcare resources.In austerity-burdened Athens, pharmaceuticals themselves have become an infrastructure of care in the absence of functional health care infrastructures. 2   The Pharmaceuticalisation of Care: From State-Driven Healthcare Policies to Today's Grassroots Distribution of Medicine One warm late Friday morning in mid-October 2016, there was no electricity at the KIA.The lights were off all over the building and volunteers were anxious about the medicine stored in the fridges: about seven containers of anticancer medication and various packs of insulin.Without electricity, in a couple of hours the fridges would defrost and this medicine would badly deteriorate.The fridges were old, common kitchen fridges that people from the neighbourhood had donated to the social clinic some years before.Together with the four volunteers on shift that morning, I sat in the small storeroom sipping my morning coffee while chatting and waiting for the electricity to come back on.The small room was stuffed with cardboard boxes filled with medical supplies and bags of medication waiting to be checked, re-labelled and stored appropriately.The small table was disorderly, covered with leftover medicine that people from nearby neighbourhoods had brought to the KIA some days before.These still needed to go through the first phase of selection before being neatly organised in alphabetical order on the shelves.The medicines also had to be grouped, their packaging repaired where torn and the numbers of pills left in each blister re-counted and updated.Additionally, those sent from abroad had to be separated from the domestic donations and from those which were to be sent to local public hospitals with which the KIA was collaborating.
Eirini, one of the volunteers, walked into the small room and, looking disconcertedly towards us, she voiced her grave concerns about the potential loss that the power cut could mean not just for the social clinic but also for those who relied on the KIA to receive their medication.She was particularly worried about the few flacons of anticancer medication stored in the fridges.These had been anonymously brought to the KIA a couple of days before, possibly by the relative of a cancer patient.Such donations were decidedly appreciated in consideration of their market cost, circa €700, but also for the affective charge that they seemed to retain: in times of deep economic recession and soaring prices, only a very economically privileged few could afford such medication which the KIA was now able to provide for free to someone else in need.
Besides Eirini's consideration of their actual market cost, what rendered anticancer medication particularly valuable was the severity of the medical condition they were meant to treat.Cancer was in fact generally considered as the ultimate disease which impacts not just the sick but also takes an emotional and economic toll on their kin.However, the volunteers always seemed to be comforted by the idea that the medication donated to the social clinic could possibly help someone else; relieving someone else's suffering or, at least, giving them hope.In the case of anticancer medicines, their value was assessed on how rarely they were donated, their actual market cost and the disease they were meant to treat.As these were very expensive medicines, such donations were also seen as a particularly generous act of care from an anonymous donor.
Picking up on Eirini's concerns, Christos, one of the few male volunteers involved in the social pharmacy, quickly mentioned that leftover of expensive medication such as the anticancer started being sold in the black market, to which people were resorting to access medications which were not available in the official pharmaceutical market.As Christos put it, selling and profiting from the despair of people in need was indeed telling of the hardship that the economic crisis had created.The black pharmaceutical market was expanding in the face of the intermittent pharmaceutical supply operated by the state institutions and people's slow descent into dire poverty in a moment when public healthcare resources dramatically shrunk. 3 Gauging and praising the morality of the donors who brought the anticancer medication to the KIA, the volunteers would often speak of cancer as a devasting social disease, that spreads suffering in the individual body and strains its sociality.In an attempt to mitigate the physical and social disruption that cancer entails, the volunteers perceived the potential loss of anticancer medication as a practical and moral failure in ensuring proper cure (iatriki perithalpsi) and care ( frontida) to somebody in need.Discussing the potential failure in keeping the medications safe and delivering them timely, the volunteers would equate the temporary malfunction of the social clinic to the chronic disfunction of the state institutions in the provision of health care.In their conversations, the state often figured as the second term of comparison against which the KIA could measure its efficiency and its commitment to provide universal health care to needy Greeks, and occasionally its shortcomings too.They would frequently utter the sentence 'We are not the state' (den eimaste kratos edo) in an attempt to distance the KIA from the state biomedical institution; however such formal distance from the state was often mitigated by their questioning whether or not the KIA might have started (mal)functioning like the state.
The ultimate sign of the state's inefficiency was indeed epitomised in media images of empty shelves in the public pharmacies and in dramatic shortage of medicine that escalated in summer 2015.At that time, many national and international media accounts reported the dire conditions of public hospitals across the country; these were often accompanied by common citizens' testimonies about their difficulties in accessing health care resources, medications or diagnostics and treatment services.Overall, the slow dismantling of the public healthcare system meant longer waiting lists to access surgeries, understaffed medical practices and hospitals and, ultimately, a chronic shortage of medications in public and state-run pharmacies and dispensaries.
Reasons for this latter, however, are multiple and exceed the trajectories of the economic crisis.In fact, the explanations behind the sudden shortage of medication lie in long-term yet unstable relations of indebtedness and corruption between the state institutions, medical doctors and national and international pharmaceutical firms (Vandoros and Stargardt 2012).In summer 2015, the government eventually admitted its incapacity to repay the debt accrued to pharmaceutical corporations which in turn opted for more stable pharmaceutical markets (Burki 2018) thus halting the pharmaceutical supply to Greek hospitals and public pharmacies.However, as already mentioned in the opening vignette of the present article, the shortage of medicine at market level did not correspond with any real shortage of medicines in the grassroots voluntary sector, which was increasingly provisioned with private donations of medicine as well as small medical items such as syringes, gloves, bandages and the like.Questioning the astonishing volume of medical donations prompts an inquiry into today's availability of medicines in households and urges a reconsideration of how these have recently flowed in the grassroots voluntary sector.With a focus on the household as a site of pharmaceutical value transition and transaction, I suggest that the social clinic's pharmaceutical capacity is derivative of previous state policies in the context of pharmaceutical distribution.
Since the 1990s, Greece has witnessed a progressive liberalisation of the pharmaceutical market which, in turn, has resulted in a wider range of medicines becoming available over-the-counter (OTC, henceforth).Such a process was originally meant to relieve pressure on the already fragile public health care system which, since its foundation in 1983, had suffered from an uneven infrastructural distribution across the Greek mainland and remote islands, as well as a pre-existing urban/rural divide in healthcare infrastructures.With a greater concentration of hospitals in mainland cities and a dysfunctional primary healthcare system, the state implicitly promoted the use of pharmaceuticals to bridge the infrastructural gap in healthcare provision (Duckett 2013).As much anthropological literature has extensively investigated (Han 2013;Biehl 2012;Van der Geest et al. 1996), a greater availability of medicine is generally meant to compensate for local healthcare infrastructure scarcity.
In the meantime, pharmacists started playing an increasingly crucial part in the process of state-led healthcare reformation by performing minor medical duties which should be carried out by doctors.In this context, pharmacies became crucial supplements to the healthcare system where a medically underserved population could more easily access medical aid and advice.It is also worth noting that in Greece, as in other developed countries (Selya 1988), pharmaceutical corporations have favoured a more intensive use of pharmacies and pharmacists as sources of direct health care. 4Throughout the 1990s and up to 2009, Greece experienced a greater availability of OTC medicine which coupled with floating prescriptions (as for Ecks and Basu 2009), a rather lax prescription system, quite a relaxed positive list 5 and generous state reimbursements for medical expenses.Such factors together resulted in a widespread habit of accumulating medicine at home where the first contact with medications often occurs (Petrounias 2016).
During one of my weekly visits to her retail outlet, Eva, the owner of a public pharmacy 6 in Central Athens, explained that pharmacists in Greece have never just been retailers, rather they have always acted as proxy-doctors, expected to provide quick, cheap therapeutic solutions to people who would otherwise have to pay for medical visits.Furthermore, as many of my local respondents in Athens reported, purchasing medication without prescription has always been rather easy in Greece.Prompted by my questions, they would often repeat you just need to go to the pharmacy of your neighbourhood [sto farmakeio tis getonias sou]: the pharmacist knows you and you know the pharmacist.You can just go there and ask for a refill.You say you'll bring the prescription later, but in the end, no one checks if you don't.Indeed, as I myself observed during my fieldwork in Athens, in many local pharmacies medicines were not transacted in a way which necessarily adhered to standard protocols: on more than one occasion, Eva would not question her customer's promise of providing the medical prescription at a later time.Similarly, she would accept the return of some medication other customers had tried but not been satisfied with.Pharmacists' accommodating attitude towards their customers and the common practice of asking the pharmacist for a refill seemingly demonstrates how pharmacists tend to trust people's self-diagnosis rather than following strict medical prescription guidelines.At the same time, such habit hints at how practices of self-medication and self-diagnosis have become constitutive of local ecologies of care, those which have grown out the entanglements of infrastructural deficiencies in health care, state policies and the role that the kinship (family, oikogenia) has traditionally held in the provision of care to its members in the face of the public healthcare dysfunctions.The pharmaceutical care provided at home ( frontida) mainly consists of pharmaceutical drugs which could be easily purchased and used at home under minimal medical supervision.However, such domestic modes of care offers symptomatic solutions to certain symptoms whether anxiety, period pain or other common conditions.For many of these conditions, especially women have developed some practical knowledge, a repertoire of go-to medication for their alleviation; a local formulary which comprises combinations of medications based on a lay reading of symptoms and the bodily response to them.
The consequences of previous pharmaceutical policies are visible in today's expansive capacity of Greek citizens to supply the grassroots voluntary sector with vast amounts of leftover or unused medicine and, more importantly, in the distinct familiarity that my local respondents in the social clinic show towards medicine.Crucially, the great majority of the volunteers involved in the KIA's operations were women: as if the KIA had actually absorbed and reproduced domestic and gendered modes of pharmaceutical care at the grassroots level.Furthermore, in lights of past state-led policies in matter of pharmaceuticals, the pharmaceuticalisation of care as experienced in Greece figures as a continuous process of a reconfiguration of health care practices which involve, on the one hand, state institutions and the market and the household and the grassroots voluntary sector on the other.At the same time, the ongoing process by which care practices are increasingly conditional on pharmaceutical availability signals how, in a context of uneven access to healthcare infrastructures, pharmacies are likely to become the most accessible places to which one can refer in order to find affordable, quick health care. 7However, the renewed availability of medicine does not necessarily imply any fairer access to healthcare resources.Access to pharmaceutical resources is still often conditional on people's private economic ability to purchase medicines and their proximity to pharmacies (Das and Das 2006), as well as on the state's capacity to ensure a steady pharmaceutical supply to local dispensaries, hospitals and pharmacies.

Trajectories of Pharmaceutical Care: From the Household to the Community
A study on Greeks' attitudes towards pharmaceuticals reported that Greek people tended to accumulate and store large quantities of medicine at home, which were likely to be exchanged among relatives and between households, amongst friends and neighbourhoods alike (Tsiligianni et al. 2012).Antibiotics and analgesics, in particular, were exchanged for use in the event of future symptoms.These types of medication could be purchased from any pharmacy without a medical prescription and, crucially, they are the medicines that were more frequently donated to the social pharmacy.As the aforementioned study shows, medicines with cardiovascular agents (56%), endocrine agents (12%) and nervous system agents (10%) were commonly stockpiled in the surveyed households: not by chance, Lasix, Triatec and Lexotanil were the medicines more likely to be found in the social pharmacy. 8Interestingly enough, former Health Minister Andreas Loverdos reported in 2012 that 4 in 10 households were sitting on quantities of unused drugs with an estimated total value exceeding one billion euros. 9 Therefore, a consideration of the household as a primary site of pharmaceutical care relations is crucial to better tracing links between the state's medical institutions (such as public pharmacies and hospitals) and social clinics as they have been reconfigured in austerity-laden Athens.In an effort to pin down the many social and biomedical lives of medicines, I account for the household as the site of mediation and pharmaceutical value conversion between the state and the grassroots voluntary medical sector.Across these realms, medicines were socialised and charged with different understandings of care and made respondent to different experiences of illness and social distress.In their transiting from state medical institutions to the grassroots voluntary sector, pharmaceutical drugs have already undergone a process of value conversion at the domestic level: in the domestic sphere they are no longer just biomedical technologies but have already become mundane objects of everyday care whose value mainly sits in their materiality.First instance, Paxson (2004) recounts how her female informants in Athens used to exchange contraceptive pills in an attempt to help each other with its detrimental side-effects and to sooth each other's concerns with unwanted pregnancies.Similarly, some of my Athenian female respondents explained how sharing pills amongst friends ultimately means caring for each other: Ioanna, for instance, explained that you can always count on your girlfriends (ta koritsia) when you run short of medication at home.'This makes you feel part of a support network which is created through sharing pills', she clarified and added that 'sharing pills is a women's thing'.In her words, women are more likely to suffer from physical ailments given their everyday engagements with domestic chores.Second, women always shoulder the burden of care and deal with kinship's demands; these often create anxiety (agxos) and nerves (nevra) for which Lexotanil and Xanax are the most common remedies which can routinely be found at home.
As objects that can be shared, pharmaceutical drugs have thus become responsive to both medical and social, individual and collective crises.Signs of their domestic sociability are visible on the packages that ultimately flowed into the social clinic: handwritten notes, names, dates and glimpses of therapeutic regimes manifest through torn leaflets left inside the often scratched packages and the unfinished blisters.Pointing out the transformations that pharmaceuticals as objects of care undergo in the domestic sphere is crucial to understand how they become constitutive of novel socialities of care in the social clinic and, by extension, at the community level.In the KIA pharmaceuticals are still prescribed for individual health problems but, at the same time, they become free floating radicals able to establish relationships of care within and beyond kinship and biomedical state institutions.
Aligning my theoretical take on medicines with an anthropological scholarship looking at the possibilities of biomedicine as improvised practices (Dewachi 2017;Street 2014b;Livingston 2012;Garcia 2010), I describe the Athenian widespread reliance on pharmaceuticals as a means of care which has long since represented 'a practical response to a pattern of intensified disengagement of social and medical services' (Garcia 2010: 65).In the Greek context, the scarcity of local services, endless waiting lists for the existing few, and the provision of suboptimal care have led families to perform social and medical triage.In the face of a prolonged lack of medical resources, sharing medical drugs amongst kin and neighbours can be read as signalling a moral and practical effort to reconstitute relations of care based on reciprocity.

Biomedical and Domestic Modes of Care: A Pharmaceutical Convergence
Anthropological literature suggests that modes and practices of care are always contextual to its situated understandings, meanings and aesthetics (among others: Aulino 2016; Thelen 2021).At the same time, care practices serve to delineate communities which, in turn, are delineated by local and vernacular understandings of 'what counts as care' (Aulino 2016).As such, the process of pharmaceuticalisation that characterises the care provision operated by the KIA is more than a situated and contextual response to the austerity-induced incapacity of the state institutions to fulfil Greek citizens' medical needs.Rather, it configures a historically grounded mode of care that has emerged from and, over time, thrived on the availability of medicine in the market.Departing from the assumption that care has the potential to transcend the boundaries of the household and the intimate relationships that delineate the modes of care within its premise, in the following section I analyse how medicines have enticed and, at the same, retained conflicting yet not mutually exclusive understandings and practices of care as enacted in the context of the KIA.
As mentioned already in the previous sections, the abundance of medicine has led to the widespread habit of storing medications at home.The medicines that had previously been bought and stored in households served people's medical needs for some time after the onset of the 2008 crisis and the implementation of austerity measures which followed and dramatically impacted state-led healthcare services.Considering the widespread tendency amongst Greeks towards polypharmacy and practices of self-medication, the vast quantity of medicines that had been amassed in households later entered the circuit of social pharmacies.Subsequently, from a diachronic perspective, a focus on the social lives of medicines allows one to trace how these have moved across different social and domestic realms and institutional and medical spheres.Such circulation also highlights the familiarity that donors, volunteers and patients attending the social clinic have developed over time with pharmaceutical technologies.In this sense, the modes of care that the social clinic pursues is not innovative per se, rather it is a reconfiguration of a domestic mode of pharmaceutical care which pre-existed both the 2008 financial crisis and the spread of social pharmacies and KIAs.This mode of pharmaceutical care also clearly underlines how state healthcare policies have been firstly absorbed into the household's relations of care (also Han 2013) and then transferred to the social clinics' mode of care, when these grassroots medical infrastructures started monopolising the Greek medical landscape in 2009.
In suggesting that Greek volunteers have extracted and relocated modes of domestic pharmaceutical care in the grassroots voluntary sector, I want to point out how two conflating understandings of pharmaceuticals as objects of care and biomedical technologies emerged in a way which roughly resonates with Pinto's (2011) description of 'rational love' and 'relational medicine'.With these two terms, Pinto highlights how disciplinary and relational modes of biomedicine converge in North Indian psychiatry: through a nuanced ethnography of how pharmaceuticals help women move through dissolving kinship relations, Pinto illustrates how pharmaceuticals are more than monolithic biomedical technologies; rather they are also flexible objects of care crucial to creating intimacy and relationality.
Similarly, in the Greek context and in a moment of socio-economic crisis, pharmaceuticals become increasingly crucial to an array of social and economic relations.In fact, they enabled the creation of bonds and affective responses among the people who handled and transacted them in the different stages of their social lives, from donation and provision to consumption.Following the social lives of medicines helps understand how the meaning and value of pharmaceuticals shift depending on each context in which they are handled and in relation to the meanings that people contextually attribute to them.When handled in the household as well as in the social clinic, pharmaceuticals acquire and retain a social efficacy which transcends the mere biomedical efficacy: as they travel across social spheres, they create values and relationships of care across temporal and spatial discontinuities.However, paying attention to the biomedical and social contexts pharmaceuticals traverse urges an analytical differentiation between the chemical/ biomedical and social efficacy they hold.Through the emic categories of frontida and iatriki peritalpsi which I respectively translate with care and cure, I want to highlight two distinct modes of care respectively afferent to the domestic and social sphere and to the biomedical domain.Through these two terms and their conceptual, relational and practical implications, I pinpoint the contextual responsiveness of pharmaceuticals to experiences of distress, being it individual or collective, social or medical.
Frontida refers to a culturally situated understanding of care and its more mundane aspects, primarily unfolding across kinship lines; as such it bespeaks material forms of help, aid and support that often entail provisioning means of subsistence such as money, food, and possibly medicine across households.At the other end of the spectrum at which care practices unfold, the biomedical mode of care (iatriki perithalpsi) is increasingly regulated through bureaucracy (Applbaum and Oldani 2010) and sustained by a biomedical understanding of the body as diseased and, as such, substantially alienated from its socio-cultural milieu.In the context of the social pharmacy, both frontida and iatriki perithalpsi hold pharmaceuticals as crucial to providing care, however they point to two opposite, yet not mutually exclusive, understandings of what pharmaceuticals are and do.
In relation to practices afferent to the domestic mode of care ( frontida) and as mundane and familiar objects of care, pharmaceuticals are both social and sociable objects which help reconstitute a sense of 'being and belonging' ( Van der Geest et al. 1996: 168) amongst people whose ill health and economic precarity pose a strain to their livelihoods.By handling and appropriating medicines that had belonged to others, those who attended the KIA as either patients or volunteers attached the promise of care to pharmaceuticals, a promise that resonates with Ecks' (2005) analysis of the role of antidepressants in India.In showing how people suffering from depression are often perceived as marginal, Ecks argues that social marginality hinges upon 'being deprived of medications ' (2005: 239) and suggests that the wider circulation of antidepressants in the market retains hope for new modes of inclusion and citizenship.Similarly, in the Athenian context, the circulation of pharmaceuticals holds the promise to reconstitute a sense of care which is contextually situated and hinges upon persistent consumption habits and shared imagination about medicines.Therefore, their efficacy is not just social but also processual and relational: their efficacy is made and remade (Hardon and Sanabria 2017: 117) through interactions and mediated by people's expectations and practices of care (Van der Geest et al. 1996;Hardon and Sanabria 2017).Along these lines, the efficacy of medicines lies in their capacity to reconfigure practices and socialities of care no longer across households, but within the community: sharing medicines represents a mode of care which magnifies their social rather than biomedical efficacy.
At the same time, the biomedical understanding of pharmaceuticals is premised on a rational and self-responsible use of medicine meant to maximise independent health outcomes.Compliance becomes 'a measure of prescribed treatment adherence by a patient' (Dumit 2010: 245) whereby individual management of therapeutic regimes must comply with a biomedical protocol to become fully effective.While this is the rationale informing practices afferent to biomedical mode of care (iatriki perithalpsi), these protocols are often detached from the micropolitics of pharmaceutical care and oblivious to the multiple uses and non-compliant practices that pharmaceuticals can invite, for instance, to silence violence and disregard within kinship relations and medical institutions (amongst others : Ma 2012;Das 2015;Pinto 2014;Biehl 2012).The flexibility of pharmaceuticals to adapt and meet different social and medical needs leans towards an ethnography-based reconsideration of how pharmaceutical regimes can entail patterns of non-compliance with biomedical protocols (Das and Das 2006).These can reveal different modes of inhabiting and coping with illness under specific socio-economic conditions and, at the same time, how biomedical technologies are shaped by local ideas of care.The sharing of medication in austerity-burdened Athens' social clinic manifests a mode of care which relies on both the social and biomedical understanding of pharmaceuticals, and was made possible by the wider circulation of medicines between households, amongst relatives and friends as well as in the market.In this sense, frontida and iatriki perithalpsi are not mutually exclusive, rather they overlap producing uncanny relations of care and lay pharmaceutical knowledge which is responsive to symptoms but rather oblivious, when not openly contrary, to biomedical precepts.

Materialities and Sociabilities of Pharmaceuticals
By 'materialities of care' Christina Buse, Daryl Martin and Sarah J. Nettleton (2018) point to the visible, mundane and often unnoticed aspects of the material culture within the health and social care context.They suggest that mundane materialities function as a lens for (re)examining care practices in diverse contexts: attending to the materialities of care enables the ordinary, tacit and non-verbal aspects of care practices to surface and become visible.Adding to the existing literature on care as a form of labour and a mode of relatedness, the concept of materialities of care provides a novel lens to explore how practices of care unfold in their most mundane aspects.As emerges ethnographically, the volunteering women I met at the KIA engaged with the most material and mundane aspects of care: the presence of medications and how they handled and talked about them evoked a sense of care and relatedness that is often associated with the intangible qualities of the domestic sphere.The domestic sphere, as already mentioned, represents the realm within which medications acquire new meanings and healing power which transcend the merely biomedical.As will be shown in the following sections, in the social clinic care unfolded through both repairing practices, aimed at fixing torn blisters and packages, and ordering activities (Bonanno 2019).Ultimately I suggest that pharmaceuticals represent familiar medical materialities whose care potential exceeds their chemical compounds.Rather, the very process of repairing, ordering, storing medications becomes an act of care in its own right.
Like any other Friday morning, I sat at the table with Anna, a long-term volunteer, who had been initially appointed as my supervisor during my first weeks as a volunteer in the social pharmacy.She revealed to me tricks and tips to speed up the process of checking the medicines.'Check the expiry date, first'; she would say sometimes people also bring expired medicines.Check the date first, if it has expired, throw it away without remorse.If you find a medicine sent from abroad, Spain, Italy or anywhere else, put them in the box labelled as translation (metafrasi) and someone else will take care of them.
Anna was a chatty, friendly woman in her mid-50s, always ready for a break (dialeimma) and a cigarette outside.That morning, an impressive amount of Lasix was sitting on the wooden table waiting to be checked.As soon as we sat down at opposite ends of the table, she forcefully pushed the box with both hands towards me.'You take care of it.I am sick of Lasix' she joked.When I asked what was wrong with Lasix, and whether she knew what Lasix was for, she amusingly explained that she did not like the colour of the blisters and found it difficult to read their printed expiry date.She was unable to give me any other explanation about this medication although she attempted by mentioning that it should help people to pee and that mainly men take it.She clarified that she was not a pharmacist, like the majority of the volunteers involved in the social clinic. 10Unprompted, she explained that almost 10 years ago, she turned to homeopathy and started practicing yoga.She proudly declared that she had quit taking medicines years ago.
When I asked Anna about her decision to turn to homeopathy and yoga, she framed her choice in terms of self-awareness and resistance to what she considered a mainstream understanding of health and illness as promoted by pharmaceutical companies with the support of the state, which actually pushed for an increasingly sustained process of pharmaceuticalisation of care. 11However, at the same time she believed that distributing medicines to people in need was a responsible act of care towards the sick and the poor who could not afford to purchase them.Interestingly, Anna had no clear idea about what the other medications stored on the shelves were precisely for.As for the great majority of the volunteers, pharmaceuticals simply represented the most immediate and effective response to other people's medical needs: as objects with curative powers that could be easily distributed, it was their very materiality that enabled the possibilities of care and the creation of caring relationships.These had the potentials to spill over the household and spread across the neighbourhood as long as the medicines kept on circulating.
Highlighting the sociality intrinsic to pharmaceutical tablets, pills and capsules, Hardon and Sanabria (2017: 117) suggest that 'there is no pure pharmaceutical object that precedes it socialization', hinting at the necessity to differentiate between the chemical properties of a given medication and its socio-cultural understanding.While shifting analytical attention from the biomedical to the social holds the promise of important theoretical contribution to the ongoing debate on today's local dislocation and reception of global medical technologies (Del Vecchio Good 2001), I consider the widespread resorting to pharmaceuticals in austerity-laden Athens as a grassroots response to a difficult socio-economic situation described by scarcity of medicine and uneven access to healthcare resources.At the same time, I hone in on the efficacy of pharmaceuticals as multiple: they do not just retain a curative power.In fact, in Athens, they are used to reinforce social relations, communicate emotions and ensure familiar modes of care in a moment when access to health care resources was increasingly made conditional on individual economic capacity.As tangible objects that can be held, handled, injected, ingested, inserted, spread onto the skin and more importantly, exchanged, the efficacy of pharmaceuticals is mainly predicated on their materiality: they ultimately are common objects of care which do both social and medical work.
As 'Materia medica' par excellence (Whyte et al. 2002), pharmaceuticals have been described as material substance with transformative, healing power: pharmaceuticals have the potential and the capacity to change the condition of the body but, in the Greek context, they prove capable of changing conditions within society as well.As a grassroots response to the healthcare crisis that Greece was experiencing, sharing medicine became synonymous with caring.Crucially enough, caring through sharing medicine points to a very mundane and material dimension of care.If we are to define care as the capacity to create and maintain meaningful ties (Thelen 2015), I suggest that these ties were constantly made and maintained because shared medicines bore the signs of their previous lives which, as such, contributed to creating a temporal continuity of care.This transcended the spatial boundaries of both the domestic and the medical domain and cemented a sense of affective bonds among the individuals who transacted, handled, shared and received them across different social spheres.
Within the perimeter of the social pharmacy in which I also volunteered for 14 months, the work the volunteers engaged in was more than just the reiteration of familiar actions of counting pills, re-labelling and fixing packaging as well as putting them in alphabetical order on dedicated shelves, in boxes and fridges.In describing the process of sorting medical discards, Halverson (2012) tells of how volunteers involved in a Lutheran mission engaged in a constant process of questioning and seeking advice, making uncertain and temporal classification and constantly reorganising supplies.Classification of medical discards, Halverson (2012: 217) points out, were routinely overturned, items reordered, new material arrived and some things appeared unclassifiable.In the context of the social pharmacies similar processes occurred and discourses on the usefulness of medications routinely intersected with affective and imaginative speculations prompted by the very materiality of the medicines volunteers were handling.
Whereas the procedure of classifying donations also entailed a process of getting familiar with their chemical compound and properties, the volunteers tended to personify the medications donated as also briefly mentioned in the opening vignette of the present article.They often described the medicine they were checking by commenting on, and often imagining, what the donor had suffered from, who had taken care of them and who had brought the medication to the social clinic.Often, the torn blisters were repaired and the handwritten notes on the packages were neutralised with a neat cross drawn by hand.These notes were reminiscent of past therapeutic regimes; some had been taken in the morning and others before sleep; others were to be taken for a few weeks only.They spoke of their previous owners' medical conditions and implicitly of their regimes of pharmaceutical care.The process of counting the pills left in each blister similarly pointed to the uncertain outcomes or even sudden changes in therapeutic regimes, while providing more details to the date of when a therapy was initiated and interrupted.Dates often figured on the surface of a package being checked; other times multiple notes overlapped, bearing the signs of one's history of illness and care.Reading the packages and blisters of these medications prompted a novel awareness of one's suffering; this, in turn, generated an affective response to the medical donations: the volunteers praised the kindness of the anonymous donors and how their donation was actually crucial to redistributing medical resources beyond economic transactions and state regulations.All the same, donating and sharing medications was an even more meaningful act of care in a moment when the economic crisis resulted in the individualisation of wealth and the privatisation of health.
Insomuch as pharmaceuticals generated affective responses in both volunteers and patients transacting and consuming them, this affective response was upheld by the actual materiality of pharmaceuticals, which in turn were attributed with, and defined by, different values which I have described throughout this article as social and biomedical.These values respectively describe and implicitly inform practices of domestic modes of care (frontida) and protocols of biomedical modes of care (iatriki perithalpsi).By emphasising the material aspect of pharmaceuticals, I point to their concreteness beyond their chemical compounds; in this I follow and at the same time I want to push further Van der Geest et al.'s (1996: 154) understanding of pharmaceuticals as objects, whose 'thingness provides patients and healer with a means to deal with the problem at hand'.Medicines, they suggest, are 'tangible, usable in a concrete way: by applying a thing, we transform a state of dysphoria into something concrete, into something to which patients and others can address their effort ' (1996: 154).In this sense, the effort the volunteers made in repairing and relabelling blisters and boxes of leftover medicines emphasises the latest phase of the value conversion process which takes place within the liminal zone of the social pharmacy, a mundane space of pharmaceutical transaction and value transition: at the intersection of a domestic mode ( frontida) and a biomedical mode (perithalpsi) of pharmaceutical care, the value of pharmaceuticals floats between the social and the biomedical insomuch as they are both active objects of care and cure.Their values are both effective/affective and biomedical: indeed, these values are expressed in the distinctive sets of ideas about biomedicine which the volunteers, the patients and practitioners attached to them. 12  The Relational Potential of Pharmaceutical Care As far as pharmaceutical drugs are increasingly seen as substituting for care as relational practice, modern healthcare science has come to consider pharmaceuticals as synonymous with caregiving (Biehl 2012).Moving on from this consideration, the general argument of the increasing individualisation of care by means of pharmaceuticals implies that a greater resort to pharmaceutical drugs is consequential to the slow waning of medical infrastructures.However, this needs to be ethnographically amended in light of the diversion from a normative framework (Beaudevin and Pordié 2016) that biomedical technologies experience once they get entangled with local ecologies of care.Whereas sharing medicine contravenes the biomedical imperative by which therapeutic regimes are responsive to individual medical needs, this practice hints at the socialities of care whose patterns and modes are redrawn by the contextual availability or shortage of medicine.In this sense, the provisioning system of pharmaceuticals pursued by the KIA represents a specific mode of care that has historically been produced and at the same time is dependent on the 2008 economic crisis.In fact, pharmaceuticals provide a familiar mode of care through which volunteers and doctors as well as the people attending the KIA could organise the practice and practicalities of care.
Whereas much anthropological literature has analysed how pharmaceuticals became a valid, yet cheap, substitute for poor infrastructure of care, in the Greek context the outbreak of the economic crisis radically changed the terms of the relationship between pharmaceuticals and healthcare infrastructures.While the absence of adequate pharmaceutical supply and provision became a defining feature of the public healthcare system, the informal provision of pharmaceuticals as operated by the KIA figured as a timely response to that pharmaceutical scarcity.This response came in the form of continuity of practices of care that state institutions had initiated.In this vein, I have suggested that the practices of care as enacted with and through pharmaceuticals represent a community-based mode of care which the KIA has lent to and extracted from home-based practices of pharmaceutical care.These have been shaped and enticed by certain state policies concerning pharmaceuticals.In adding to the ongoing debate on pharmaceuticals as individualised technologies of self-care, I have shown how in the context of the social clinic, the process of sorting pharmaceuticals as a practice of care generated relationships and relatedness amongst the female volunteers that took part in the KIA's activities as well as between them and the patients who relied on the KIA.Rather than atomising regimes of care, pharmaceuticals thus contribute to socialising and collectivising care, further blurring the boundaries between the private and the public.
12. Holding on to a commodity theory of Marxist derivation, Halverson (2012) describes the process by which medical discards are re-activated into commodities in terms of redemptive economies.While I am aware that a similar perspective can be applied to the recycling circuit set up by the KIA, I do not focus on the economic value of medicines.I am interested in exploring the polysemic nature of pharmaceuticals as bearing both social and biomedical values.