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In the wake of the AIDS pandemic, legions of organizations and compassionate individuals descended on Africa from faraway places to offer their help and save lives. This book shows how the dreams of these altruists became entangled with complex institutional and human relationships. The book describes the often mismatched expectations and fantasies of those who seek to help, of the villagers who desperately seek help, and of the brokers on whom both Western altruists and impoverished villagers must rely. Based on years of fieldwork in the heavily AIDS-affected country of Malawi, this book digs into the sprawling AIDS enterprise and unravels the paradoxes of AIDS policy and practice. All who want to do good—from idealistic volunteers to world-weary development professionals—depend on brokers as guides, fixers, and cultural translators. These irreplaceable but frequently unseen local middlemen are the human connection between altruists' dreams and the realities of global philanthropy. Personal stories, public scandals, and intersecting, sometimes clashing fantasies bring the lofty intentions of AIDS altruism firmly down to earth. The book ultimately argues that altruists could accomplish more good, not by seeking to transform African lives but by helping Africans achieve their own goals. It unveils the tangled relations of those involved in the collective struggle to contain an epidemic.

This book explores the contradictions inherent in one particular health care market—hospital care. Based on extensive interviews and observations across the three hospitals of one California city, the book examines the tensions embedded in the market for hospital care, how different hospitals manage these tensions, the historical trajectories driving disparities in contemporary hospital practice, and the perils and possibilities of various models of care. The book's three featured hospitals could not be more different in background or contemporary practice. PubliCare Hospital was founded in the late nineteenth century as an almshouse in order to address the needs of the destitute. HolyCare Hospital was founded by an order of nuns in the mid-twentieth century, offering spiritual comfort to the paying patient. And GroupCare Hospital was founded in the late twentieth century to rationalize and economize care for middle-class patients and their employers. The book explains how these legacies play out today in terms of the hospitals' different responses to similar market pressures, and the varieties of care that result. The book is an in-depth investigation into how hospital organizations and the people who work in them make sense of and respond to the modern health care market.