Medicine Anthropology Theory
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Collaboration and critique: In between the Battelle Diagnostic Inventory and ethnography
Get PDFWhat is the place for critical ethnography in global health and other related forms of international intervention? This essay explores this question through my experience collaborating with a nongovernmental organization (NGO) working to improve children’s well-being in El Salvador and with a team of quantitatively oriented researchers evaluating the NGO’s project. I adopt as an analytic lens one of the metrics the researchers used – the Battelle Developmental Inventory – in order to explore the possibilities for dialogue among quantitative and qualitative methods (and researchers). At issue is the place that critique can have in such dialogues, particularly when the aims of NGOs, public health researchers, and ethnographers can sometimes be at odds. Ultimately, I make the case that viewing critique as a praxis, keeping an eye on the commensurability of aims, and being prepared for occasional productive friction are some practical steps for bringing critical ethnographic perspectives into contact with interventions
Soap: Touching objects, feeling critique in critical global health studies
Get PDFAnthropology has long grappled with the politics of critique. In critical global health studies, an emerging subfield of medical anthropology with roots in histories and geographies of colonial and international health, ethnographers negotiate relations and transactions in the field that pivot around boundaries at the core of our disciplinary practice: inside/outside, critique/complicity, theoretical/applied. Yet, while critique is a primary endeavor of the anthropologist, few have explicitly analyzed or reflected on its meanings, valences, affects, and entailments, particularly amid the rise of global health and the NGOization of the global South that inflects much of our work. In this essay, I reflect on the state of critique in critical global health studies, sketching its gestures, rhetoric, and intentions. Then, I trace some of the journeys of the bar of soap pictured below, an object that touched me in many senses of the term by intersecting, facilitating, and holding my anthropological interest for over a decade. Finally, drawing on recent feminist science studies scholarship, I suggest that critique, as entangled and entangling practice, is a form of care that might productively reframe anthropologists’ normative aspirations to ‘usefulness’ or ‘relevance’
Introduction: Objects of critique in critical global health studies
Get PDFAs an emerging subfield of medical anthropology with roots in histories and geographies of colonial and international health, critical global health studies reflects both changing modes of health practice and the centering of critique as a core anthropological endeavor. This special section seeks to analyze and reflect on the meanings, valences, affects, and entailments of anthropological critique, taking the rise of global health and flourishing of global health ethnography as key sites of investigation. Each of the contributing pieces is oriented around a global health object or technology
Rationalized aging: Creative destruction and the subdivision of US eldercare
Get PDFThere are approximately 4.4 million direct-care workers in the United States. Comprising the labor of nurses, home health aides, certified nursing assistants, personal attendants, and companions to the elderly, direct-care work constitutes one of the fastest-growing labor niches in the United States. Within the commodified caregiving sector, cost-cutting imperatives to subdivide care labor introduce insalubrious complications for patients by cleaving – or attempting to do so – their physical needs from their emotional and relational needs, a process that I label ‘rationalized aging’. In this essay, I reflect on my experiences as a paid elder companion in New York City to argue that this process of subdivision combines earlier nineteenth-century rationalization strategies with neoliberal regimes of flexible accumulation and to highlight the consequences of subdivision in this sector both for care workers and for the patients in their care
Viral sovereignty: Security and mistrust as measures of future health in the Indonesian H5N1 influenza outbreak
Get PDFIn the mid-2000s, Indonesia became ‘ground zero’ for an outbreak of highly pathogenic avian influenza, the H5N1 strain, which global health experts feared would cause a devastating pandemic. When asked to participate in global health measures, Indonesia’s minister of health argued that the country had ‘viral sovereignty’ and refused to share samples with the World Health Organization’s Global Influenza Surveillance and Response System. The global health community claimed, in response, that such refusal put all humanity at risk. Both sides of the debate expressed paranoia, resentment, and mistrust as their different ideas of security came into play. In the midst of these accusations and counteraccusations, little attention was paid to the larger social and ecological context in which the virus had emerged and flourished. I argue that when vital matter gets taken up within frameworks of security, human and animal bodies, narratives, and politics get scripted through concerns for biological and political vulnerability. Paranoia, resentment, and mistrust resonate as the multiple vulnerabilities of bodies and their social positioning frame uncertain futures
Opening up ‘fever’, closing down medicines: Algorithms as blueprints for global health in an era of antimicrobial resistance
Get PDFRising concerns about antimicrobial resistance have sparked a renewed push to rationalise and ration the use of medicines. This article explores the case of the Integrated Management of Childhood Illness (IMCI) guideline, a periodically updated ‘global’ algorithm that shapes and normalises the centrality of medicines to care in low- and middle-income countries and, increasingly, the imperative to ration them. Using ‘classification work’ as analytic frame, we firstly consider the IMCI algorithm as a blueprint for global health that classifies illnesses, patients, and care in particular ways relative to available medicines. Zooming in on this blueprint, we then offer a classificatory reading of ‘fever’ over time, tracing ‘nonmalarial fever’ from being malaria’s residual ‘other’ category to becoming increasingly legible through attention to diagnostics and antibiotic (over)use. Our reading suggests that an apparent refinement of the ‘fever’ category may concurrently entail the closing down of medicine options. This raises the possibility that an increasingly high-tech but ‘empty’ form of pharmaceuticalised care is being incidentally worked into the infrastructure of weak health systems
Dr. Ram’s triage: Categorization, speculation, and granting access to global health technologies in Indian private clinics
Get PDFTriage is a process of categorizing potential health and guiding care. It is based on the idea that all bodies are equal while potential vitality is not. I examine the triage processes used by Indian physicians as they collaborated with global health researchers to identify patients for a free, cutting-edge tuberculosis test. As I argue, triage forms and reforms social difference within global health despite its aspirations of standardization and experimentality. Problematizing triage as part of global health’s ordinary affect of affordability reveals local biologies, class biopolitics, and clinical speculation in the field. I conclude by considering new avenues of ethnographic inquiry that are opened by attending to the practiced and depoliticized biopolitics that occurs within clinics as everyday, nonreflexive decisions about how to organize resources and speculate on vitalities
Neocolonial epidemiology: Public health practice and the right to health in Guatemala
Get PDFThe relationship between public health practice and the fulfilment of the right to health is often assumed to be synergistic. With the goal of understanding how exactly this relationship happens, I studied the everyday practice of epidemiology in Guatemala, seeking to understand how it shapes and is shaped by the notion of health as a human right. Here I present findings from my ethnographic investigation of the Guatemalan Centro Nacional de Epidemiología (National Epidemiology Center), created in 2004 with the explicit mission of contributing to fulfilling the right to health for the inhabitants of Guatemala. While the relationship between epidemiological practice and the right to health is influenced by the specific configuration of local and transnational flows (bureaucratic, economic, ideological, political, scientific, social, and symbolic), epidemiologists also play an important mediating role. There are four intermediate social mechanisms that shape the relevance of epidemiological practice to fulfilling the right to health in Guatemala. Given how the country’s economic and social inequalities translate into enormous health inequities, an epidemiological practice committed to the right to health should aspire to transform, rather than reproduce, the social hierarchies underlying such inequalities. The mechanisms I identified shape how epidemiological practice contributes to the reproduction or transformation of such hierarchies. These mechanisms shape what I call ‘neocolonial epidemiology’, and include: institutional chaos, disciplinary conformism, global health international relations, and social relations at the national level
Ethnography in a grievance: Documentary mechanisms in Nicaragua’s chronic kidney disease epidemic
Get PDFThis essay discusses documentation as a critical practice that links ethnography and activism. It describes the efforts of Nicaraguan sugarcane workers to use World Bank mediation and corporate social responsibility ‘mechanisms’ to call attention to the health and environmental problems that attend plantation production. Documentation becomes essential to activism when the lines of cause and effect that link bodily conditions to ecological conditions are unclear or contested. As a form of evidence-making that blends the archival and the ethnographic, documentation helps not to isolate facts but to construct context