Medicine Anthropology Theory
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The Walls Have Ears: Accessing Participant Narratives amid Silence, Secrecy, and Mistrust
No full textEritreans have long been considered a close-knit community bound by the memorialisation of history and the preservation of cultural practices. My anthropological enquiry into the everyday experiences of mental distress among diasporic women revealed that the depth of their exclusivity was a response to the continual and unsystematic surveillance of the Eritrean state. Government spies targeted outspoken critics, either forcing them into exile or pushing them into perpetual silence. In this essay, I explain how the perceived looming presence of secret agents created widespread mistrust and pervasive silence that complicated relationship-building among diasporic women. I then describe how negative perceptions of the term ‘mental health’ required an alteration of my lexicon and methodological approach, revealing the embodiments of silence and distress in everyday interactions. By reflexively and critically engaging with women’s everyday experiences, silence emerges as a central theme in my work, eventually becoming a conceptual anchor that has helped me understand and connect with a politically silenced diaspora. Through these ethnographic encounters, the complexities of the social, cultural, and political interactions gave meaning to simple utterances
Following Tanya’s Lead: The Mirage and Hope of Social Medicine Research
No full textEntrenched structural inequalities raise challenging questions of how socially-oriented research initiatives are likely to improve health for marginalised people. The recent inclusion of transgender women in the National HIV Behavioral Surveillance (NHBS), an ongoing initiative funded by the Centers for Disease Control and Prevention (CDC) to study the HIV epidemic in the US, is designed to redress the exclusion of transgender people from past HIV research and to confront the disproportionate burden of HIV on transgender women through the production of specific knowledge about HIV risk factors in this population. The hope is that such research will ameliorate the burden of HIV among transgender women. Building on a decade-long ethnographic engagement with transgender activists and health practitioners, I delve into tensions between the health research that sustains this horizon of hope and what I call the ‘mirage’ of social medicine research. My interlocutors call out this mirage of scientific optimism in which ‘all the answers are already known’, suggesting that health research oriented towards social justice simply begets more research. Nonetheless, my interlocutors engaged with me, a physician-anthropologist trainee, in order to insist on the ethical necessity of including transgender people in health research even as they exposed the limits of such inclusion and, more broadly, the limits of medicine’s power to redress social injustice. We should follow their lead, embracing neither futility and hopelessness nor the mirage of medical salvation, in order to build collaborative relationships in the service of a more caring social medicine
Diagnosing Diabetes, Diagnosing Colonialism: An Ethnography of the Classification and Counting of a Senegalese Metabolic Disease
No full textThis article explores the top-down production of the statistics frequently circulated in global health. These data must first originate in a place like the public hospital in Saint-Louis, Senegal, in doctor’s offices and laboratories and medical archives. At their root, these data are an accumulation of individual bodies, experiences, and intimate diagnostic moments. This aggregation turns the afflicted into categories and statistical regimes that shape a global health understanding of diabetes specifically, and noncommunicable diseases broadly. This article explores the individual diabetes diagnostic moment itself and the politics of the current nosology of Type 1 and Type 2, a seemingly neutral dichotomy that belies colonial relationships between Senegal, slavery, sugar production and consumption, and the effects these relationships have on contemporary conceptions of diabetes diagnosis in Senegal and global health
What Could Be, But Never Has Been: Horizons of Human Rights and Racial Justice
No full textThe US’s authority as chief enforcer of human rights grows increasingly illusory as civil unrest brings the quotidian nature of racialised human rights violations in the US into a frame shared by authoritarian regimes. This reality animates my analysis of how an organisation I call Doctors for Humanity (DfH) finds its footing in a terrain of human rights enforcement that is shifting from a global to a domestic focus. The US is not an actual space of freedom but often represents the limit of possible freedoms. This horizon evokes something that always could be but never has been and unmasks what I analyse as a constitutive unfreedom at the heart of liberalism in American empire. To attend to human rights violations in the US is to undermine American authority and its right and responsibility to make claims about the actions of other nations. As a future physician and human rights advocate invested in racial justice, I illuminate the paradoxes of ethical action within a context where the possibility of freedom for some depends upon the unfreedom of others. To effectively police human rights from this perspective necessitates the deconstruction of the US as a space of freedom, pointing instead towards a praxis of global human rights which lives up to the concept’s aspirational universality
Dis/Avowing Masks: Culture, Race, and Public Health between the United States and Taiwan
No full textCOVID-19 brought masking, a practice that was largely confined to certain technical occupational settings in the US, into the heart of a national controversy. As with prior emerging infectious diseases (such as HIV, SARS, and Ebola), US public health experts and governmental agencies positioned themselves as authoritative producers of emerging scientific knowledge, including best practices for public masking. US epidemiological outcomes, however, have sorely lagged behind many other countries. The US leads the world in confirmed cases of and deaths from COVID-19, undermining presumed hierarchies in global health authority today. In this essay, I compare US and Taiwanese masking policies, delineating how social relations of care in the US become sites of political conflict within a hierarchical global ecology of scientific knowledge and medical supplies. Drawing upon my experience as an MD/PhD in anthropology trainee studying emerging infectious diseases and as a Taiwanese American immigrant, I explore conflicts over mask acquisition and usage across borders and time, illuminating global inequities of scientific knowledge production and pandemic containment and underscoring racialised disavowals that persist in US public health. These racialised disavowals illustrate the structural limits that circumscribe possibilities of containment during an uncontained pandemic
“Doing it Our Way” Participation and Kinship in Traditional Surrogacy Narratives in Aotearoa New Zealand
No full textThe practice of traditional surrogacy gives rise to multiple discourses around women’s autonomy and kinship practices globally. In the Aotearoa New Zealand context, traditional surrogacy (where the surrogate donates her own egg as well as gestating the foetus) is legal only on an altruistic basis. Furthermore, it is subject to neither medical nor state oversight, unlike gestational surrogacy which is heavily regulated. Drawing on three years of ethnographic research, this article focuses on both traditional surrogates in Aotearoa New Zealand who have children of their own and those who have chosen a childfree life. Their narratives reveal multilayered motivations that align with and diverge from the ‘help’ narrative often associated with altruistic surrogacy. By drawing on and contributing to current debates on surrogacy globally, I show that traditional surrogates take on their role with clear ideas about kinship and different interpretations of reproductive participation. Their narratives bring to the fore the under-researched topic of traditional surrogacy, and in particular of women who do not want children of their own but choose to donate their eggs and gestate the foetus for another woman. I argue that their negotiation of stigma to make/resist kin disrupts pervasive heteronormative modes of kinship
(In)Visible Disease: Motions and Emotions Engendered by Papers and Diagnostics of People Accessing Healthcare in Burkina Faso
No full textWithin the last decade, challenges of diagnosis have emerged on the global health agenda, accompanied by an expansion in the use of point-of-care and rapid detection devices in low-resource contexts where laboratory facilities are scarce. Few studies have explored how these changes are shaping people’s diagnostic journeys and their modes of accessing such technologies. In this paper I show how sick people and their families in a peri-urban area in Burkina Faso attempt to access diagnostic technologies and make themselves visible to the healthcare system through papers. In this context, I show how referral papers and diagnostic papers take on significance for people as they attempt to access care and diagnostic technologies and ‘carry’ knowledge between different levels of the healthcare system. The use of papers is often an uncertain undertaking, as they remain unintelligible to the sick and the layperson. I highlight how the form of the papers makes a crucial difference to the ways that sick people are able to use them. Papers and diagnostic technologies present both opportunities and challenges, and simultaneously engender hope, uncertainty, disappointment, and despair for the sick seeking a cure. Uncertainties, especially financial ones, arise with the possibility of new referrals and diagnostic tests, and along the way many give up or are immobilised when faced with diagnostic ambiguity
‘Test, Test, Test!’: Scarcity, Tinkering, and Testing Policy Early in the COVID-19 Epidemic in France
No full textThis article follows the introduction of COVID-19 polymerase chain reaction (PCR) diagnostic tests in France. It shows how, at the intersection of science, medicine, politics, and policy-making, the test, trace, and isolate (TTI) strategy played out during the first months of the pandemic against a backcloth of multiple shortages. In so doing, the authors move beyond trite explanations (such as ‘French public health’s backwardness’) to highlight how successive policy inflections affected the national response to the pandemic. The piece analyses the shifting French political discourse surrounding (scarce) COVID-19 tests while exploring ad-hoc regulations and guidelines as well as the intense ‘bricolage’ that they triggered in the field of clinical medicine. The authors contend that the limitations of the testing infrastructure in France during the first half of 2020 shaped the decision to resort to lockdown. The research article sheds light on two coexisting registers of professional uses of reverse transcription-polymerase chain reaction (RT-PCR) assays—a ‘public health use’ and a ‘clinical use’—and highlights the changing political and social relevance of these two registers, with scarcity as a major determinant of these changes. One of the striking aspects of the introduction of COVID-19 tests in France therefore lies in the enduring gap between the dynamics of the epidemic and the dynamics of testing. In this respect, the French situation is neither extreme nor unique, which makes this case study a relevant basis for the international comparison of testing practices in different phases of the COVID-19 pandemic