Based on ethnographic research conducted in a government hospital in Tanzania, this article explores how global and state governance molds hospital spaces. While some spaces in the hospital are made global through regimes of governance, others—by virtue of being beyond state/donor interest—remain decidedly local. The unequal material configurations characteristic of layered hospital spaces mean that some actors can realize meaningful identities as patients and health professionals, whereas others cannot. Drawing on a case study of one patient’s movement from an inpatient ward to an HIV/AIDS clinic within a government-operated hospital, this article reveals the ways that forms of state/donor governance can create multiple spaces, places, and persons within the same institution.