Medicine Anthropology Theory
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Hidden Perils: Diagnosing Asymptomatic Disease Carriers
No full textCOVID-19, a disease induced by SARS-CoV-2, became a worldwide pandemic while SARS, a disease induced by a closely related virus, SARS-CoV, was successfully contained. This is because COVID-19, unlike SARS, can be spread by people who do not display any symptoms of disease, either because they are in the early stages of the infection or because their infection remains clinically silent. This research article traces the complex history of the diagnosis of symptom-free (or asymptomatic) carriers of pathogens, a term inseparably linked to the rise of the laboratory diagnosis of pathogens. Only such a diagnosis can reveal that an apparently healthy individual harbours dangerous bacteria, parasites, or viruses. The article begins with the iconic story of ‘Typhoid Mary’, a New York cook found to be an asymptomatic carrier of typhoid fever microbes. It then discusses divergent approaches to the treatment of symptom-free carriers of hookworm and controversies around the screening of HIV carriers, especially before the development of anti-retroviral treatments. It concludes with a presentation of the debates on the role of asymptomatic carriers in the spread of COVID-19 and of the differences between the approaches of countries seeking to eliminate this disease, a goal that itself entails tracing and isolation of all asymptomatic carriers of coronavirus, and those trying to contain it, an approach that tolerates the presence of a limited number of ‘invisible’ virus carriers
Infrastructures of Suffering: Trauma, Sumud and the Politics of Violence and Aid in Lebanon
No full textThis article traces the infrastructures of suffering under the governance of humanitarian psychiatry to explore how material conditions of war and aid have shaped the politics of trauma and sumud[steadfastness] in Lebanon. Based on 29 months of ethnographic fieldwork undertaken from 2011 to 2013, I look at the expert, economic, and techno-political assemblages of trauma and sumudduring the July War in 2006 and the Syrian refugee crisis in 2011. Mental health experts faced unexpected difficulties in diagnosing war trauma during the July War. This led political actors to claim that these difficulties reflected a general absence of suffering from war and a sign of Lebanese resilience, drawing on economies of sumudin postwar reconstruction. The Syrian refugee crisis however radically transformed the politics of suffering in Lebanon. A new political economy of trauma emerged where the Lebanese now competed with other aid communities to have their past suffering recognised as traumatic. Comparing the relations between violence, aid, and suffering in both instances serves to contextualise and historicise suffering beyond a particular discourse or event. It also serves to highlight the contingencies of suffering rather than its internal and psychic elements
Comparative Explorations Of Human-Poultry Relationships, Pandemic Preparedness and the Search for Viral Epicentres
No full textIn this book review, I compare three timely ethnographies that critically explore the topics of human–poultry relationships, avian influenza, and global health. I start the review by considering how the three authors, each located in a different context, approach these topics by drawing upon distinct methodological and theoretical frameworks. I then show how these approaches shape the way in which the authors discuss three separate concepts: preparedness, experiments, and viruses. I conclude that, whether read independently or together, these books illustrate the power of ethnographic research in exposing the distinctive ways that people envisage the relationships between human and non-human lives and the implications of such distinctions for disease control
Psychosocialization in Nepal: Notes on Translation from the Frontlines of Global Mental Health
No full textAs ‘psychosocial interventions’ continue to gain traction in the field of global mental health, a growing critical literature problematises their vague definition and attendant susceptibility to appropriation. In this article, I recast this ill-defined quality as interpretive flexibility and explore its role in processes of translation occurring at the frontlines of care in rural Nepal. Drawing from 14 months of ethnographic fieldwork among community-based psychosocial counsellors, I consider how the broad and flexible notion of the ‘psychosocial problem’ operates as a ‘boundary object’ in transnational mental health initiatives—that is, how it facilitates the collaboration of service users, clinicians, donors, and policymakers in shared therapeutic projects without necessarily producing agreement among these parties regarding the nature of the suffering they address. I suggest that psychosocial interventions may be gaining popularity not despite but precisely because of the lack of a unitary vision of the problems psychosocial care sets out to alleviate. In closing, I reflect on what distinguishes ‘psychosocialisation’ from medicalisation and highlight the limitations of the latter as a critical paradigm for the anthropology of global mental health
Global health Initiatives as a ‘Drunken Boat’: The Meningitis Vaccines Project Case Study
No full textBased on an analysis of the Meningitis Vaccine Project (MVP), a public-private partnership (PPP) set up to introduce the MenAfriVac® vaccine in African countries, this article examines the failures of an accelerated disease control programme that targeted a highly infectious disease. I argue that the integration of MenAfriVac® into the World Health Organization’s (WHO) Expanded Programme on Immunisation had the effect of reinforcing inequalities in access, in particular during epidemic emergencies. I will also show how vaccine shortages during an outbreak in Niger led to political tensions and to the emergence of a parallel and unregulated ‘black market’ of vaccines
The Testing Database as Pandemic Technology: Reflections on the COVID-19 Response in India
No full textThis article examines the COVID-19 response in India, viewing it as deeply enmeshed in the dynamics of the ‘database’ as an emerging technology of governmentality. Databases aim to translate entire populations into units of information abstracted from social identities and local specificities. In the context of the coronavirus pandemic, bureaucratic state systems attempt to manage and respond to the health crisis via databases collating testing data across the country. Problematising COVID-19 testing databases, we delve into the logic of database governance. We find that as a tool of governance the database falters in its attempts to compress complex identities and locations into de-contextualised units of information. As the complexity of lived reality interrupts the logic of databasing, state discourse on ‘unintended consequences’, ‘leakages’, ‘duplication’, and ‘reconciliation’ processes in the management of databases abounds and the ambivalence of databases becomes manifest in the COVID-19 response. In this article, we use secondary data to understand how testing databases intervene and interact with complex realities to establish bureaucratic order around a pandemic. We posit that COVID-19 testing databases should be understood as being embedded in emerging database governmentalities that supplant care of the population with the maintenance of databases
Detecting Diabetes Risk: Philanthrocapitalism, Diagnostic Innovation and Epistemic Power in Mexico
No full textAn expanding class of mega-philanthropic institutions, most often based in the Global North but increasingly based in the Global South, has emerged as a driving force in global health. Among them, the Carlos Slim Foundation—located in Mexico City and funded by Mexican-born telecommunications tycoon Carlos Slim Helú—has spearheaded an ongoing strategy to boost chronic disease prevention in Mexico, principally through the development and promotion of a series of cutting-edge diagnostic tests. In this research article I trace the Foundation’s efforts to develop these technologies and integrate them into Mexican health policy. With these technologies serving as powerful conduits of the Foundation’s epistemic power, I show that Carlos Slim’s philanthropic investments are reshaping goals in the public health field and fostering new understanding of chronic disease risk among health officials and experts in Mexico and beyond
Diagnostic Citizenship and the Biopolitical Uptake of COVID-19 Detection
No full textThis essay examines an oddity of SARS-CoV-2 diagnostic testing—referred to here as a ‘persistent positive’—in which an individual can test positive for COVID-19 for weeks or even months after initial infection despite no longer being symptomatic or contagious. In Florida, where recent legislation requires healthcare workers affected by COVID-19 to have two negative test results before they can return to work, the issue of persistent positives poses a significant challenge for a small sub-group. I identify an important disconnect between the biological and the biopolitical where SARS-CoV-2 test results are mis-inscribed into biopolitics as bureaucratic state legal codes and employment requirements. Using ethnographic evidence, I show how their test results are less important than the state’s interpretation and enactment of these test results. I describe a techno-political phenomenon wherein the technical (in this case diagnostic testing) selectively offers up rights to those recovering from COVID-19. Those with persistent positives performatively engage in testing as a means of navigating the legal codes that deny them the right to work. Testing for them is an attempt to return to a normal life, not to find out whether they are living an abnormal one. A breed of biological citizenship, perhaps a diagnostic citizenship, is formed in which they need a certain result, no matter what that result means biologically, in order to exercise certain rights. These reflections encourage a rethink about the role of testing technology as an instrument of government and biomedical authority more broadly.  
COVID-19 Diagnoses: A Source of Immanent Value and Novelty
No full textAlthough the body is fundamental to observation and feeling, its experience of infection is regarded by the biomedical sciences and, for the most part, the social sciences as relatively obtuse. The body is situated as a mere object of inquiry, as if its intricate and highly complex dynamics indicate that it is no more than an imperfect animated machine and, concomitantly, infection simply a change to its normative mechanisms. In this Position Piece, I ask: what might be afforded to the problematic diagnosis of communicable infection and to global health strategies of containment if the body were appreciated as an active participant in diagnoses? To do so, I take up the ‘pluralist panpsychist’ proposition that bodies think. Counter to the view that thinking is the preserve of the human mind and that value is an ‘after’ ascribed to a given fact or situation, I experiment with the idea that the body’s sensory awareness can be thought as a creative source of immanent values. Drawing on a series of empirical examples primarily focused on the perceived novelty of COVID-19, I offer a preliminary sketch of how revaluing the body as involved in decision-making and novelty might enrich the scope of biomedical and social diagnoses