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MAGic2015: Anthropology and Global Health: interrogating theory, policy and practice

(P19)
How 'global' is Global Health? Mobility and (dis)connectivity in the Global Health enterprise
Location JUB-144
Date and Start Time 10 September, 2015 at 11:00
Sessions 2

Convenors

  • Dominik Mattes (Freie Universität Berlin) email
  • Hansjoerg Dilger (Freie Universität Berlin) email

Mail All Convenors

Short Abstract

How do health conditions become problems of "global concern"? What connectivities and hierarchies are established between multiple actors of Global Health? This panel explores how Global Health is "patterned" by (dis)connections, directionality, (in)equality, neglect and newly emerging solidarities.

Long Abstract

Mobility and connectivity are central elements of the field of Global Health. Thus, the increasing mobility and connectedness of persons, pathogens, and politics across national and regional boundaries produce often novel health conditions of potentially global urgency. The responses to health issues, in turn, trigger (equally transnational) flows of finances, policies, and medico-technical interventions establishing new types of assemblages with an often strong humanitarian impetus. This panel interrogates how the field of Global Health is "patterned" by geopolitical power relations, conditions of inequality and vulnerability, and the agendas and strategies of particular actors. Workshop submissions should pay special attention to the phenomena of (dis)connectivity, mobility, directionality, (in)equality and neglect. They may address why certain health conditions become the target of global health interventions while others, that are similarly "urgent" in terms of morbidity and mortality, do not attract the same medical, political and financial attention? Which (geographic as well as metaphoric) spaces and types of problems remain unmarked in the Global Health landscape? How does the "Global North" become part of the Global Health paradigm, other than intervening in the health crises of the "Global South"? Do notions of Global Health that pay attention to "austerity" and "crisis" in the "Global North" simply replace geographical boundaries by markers of class, ethnicity or race? Finally, what (new) connectivities are established between the multiple actors of the Global Health enterprise, and how do they produce new solidarities, but also hierarchies and power relations in "South-South" or "East-West" cooperations?

This panel is closed to new paper proposals.

Papers

Within the Gaps of Global Health: Clinical Volunteering, Marketed Scarcities, and Emerging Connectivities in Tanzania

Author: Noelle Sullivan (Northwestern University)  email

Short Abstract

Among foreign volunteers in Tanzanian health facilities is a growing number of volunteers from other African countries. What can engagements within the gaps in Global Health tell us about emerging global connectivities and their politics?

Long Abstract

Somewhat neglected within existing Global Health literature, one phenomenon has attracted significant attention among (aspiring) health professionals largely from the Global North: clinical volunteering in the Global South. While gaps in Global Health priorities are a 'push' factor for mobile actors to travel, some health professionals in the Global South look to clinical volunteers as a prospective means of attending to the very scarcities that attract foreigners to these places. Drawing from ethnographic data collected in Tanzania over four field seasons since 2008, this paper considers established as well as emerging shifts in the connectivities that characterize global health volunteering. Among the foreign volunteers crowding the neglected wards and clinics of Tanzanian health facilities is a growing number of volunteers from other African countries. Foreign African volunteers, like their peers from the Global North, anticipate that these experiences in Tanzania will bolster their professional trajectories in medicine or global health back home or abroad. As Tanzanians host foreign volunteers in hopes of forging cooperations to address prevalent scarcities in their health facilities, I ask: what new assemblages are emerging or aspired to in the gaps of Global Health priorities? What can engagements within the gaps in Global Health tell us about emerging global connectivities and their politics? What is at stake when the scarcities of medical systems become commodities for mobile actors within both the Global North and the Global South? Ultimately, what (in)equalities, possibilities and constraints emerge within the gaps of the formal Global Health enterprise?

Health and hierarchy: mobility and desire in East African capacity building

Author: Branwyn Poleykett (University of Cambridge)  email

Short Abstract

Training and capacity building represents an important axis of connection across distant spaces and unlike times. This paper explores circuits of exchange of capacity between Denmark and East Africa reflecting on the recent past of global health and on its future.

Long Abstract

Global health programmes rely on a reserve pool of local auxiliary labour: technicians, laboratory assistants, and public health workers to accomplish their goals. Northern institutions which attempt to foster and build scientific capacity in Southern states try to anticipate the coming scientific economy as well as to produce partnerships which are equitable and sustainable. Training and capacity building therefore represents an important axis of connection across distant spaces and unlike times.

This paper tracks across time, between colonial and postcolonial institutions and European and African contexts in order to understand how flows of 'capacity' shape the skills and desires of African scientists and technicians and how capacities in science are gained, lived, and lost, over time. Biographical research with European scientists in Denmark and African scientists and technicians in Kenya and Tanzania reveals how global health is shaped in context by its recent pasts. This research also draws attention to the ways in which skill and capacity come together and cohere over the line of a life, showing how abstractions like global and local scientific economies shape the possibilities for a just global health movement.

Site's resistances, health providers' deficiencies, women's negotiation: about prevention of mother-to-child transmission of HIV (PMTCT) in Cameroon

Authors: Annick Tijou Traore (Les Afriques dans le Monde)  email
Josiane Tantchou (CNRS)  email

Short Abstract

We look at site-level deficiencies (spatiality, mobility and transportation) to understand why prevention of mother-to-child transmission (PMTCT) interventions are not increasing as fast as expected.

Long Abstract

Over the past few years global health initiatives have made significant financial resources available for scaling-up antiretroviral treatment (ART), including PMTCT programmes. However, the percentage of women involved in prevention of mother-to-child transmission (PMTCT) interventions is not increasing as fast as expected (UNAIDS, 2014). The problems and challenges stated since the beginning of the 2000s are still relevant. Anand, Shiraishi & al. remarked that evaluations of PMTCT programmes have focused on the role of behavioral factors whereas efforts should also investigate the role of site-level deficiencies (Anand, Shiraishi et al. 2009). That's the path we want to follow. In line with certain authors (Campbell, Cornish et al. 2012; Jewkes and Morrell 2012), we advance a position that acknowledges both the domination of the changing global policies and knowledge regarding PMTCT, and the agency of local actors in negotiating or resisting these policies. We describe PMTCT programme as a changing field; then we consider the materiality and spatiality of our study site in terms of mobility and transportation, and show how its (dis)connections from its surroundings limit the appropriation of new guidelines and constrain the provision of supplies as well as the agency of local actors in negotiating or resisting these policies in ways that fit their values or maintain their professional routines.

Barren and Fertile Grounds for Imaginary Futures - An Anthropological Perspective on the Politics of Infertility Treatment in Urban Kenya

Author: Nicole Ahoya (University of Zurich)  email

Short Abstract

Fertility and infertility in sub-Saharan Africa receive unequal global attention. The paper explores whether the neglect of infertility in global health programs affects the outcomes of programs for prioritized health conditions and how new forms of biosociality emanated due to the lack of resources.

Long Abstract

Infertility in the context of sub-Saharan Africa seems to be a striking paradox. Overpopulation and life-threatening infectious diseases dominate the globally circulating discourses which have an immense effect on the direction of foreign aid and on its justification. The emphasis on the reduction of birth-rates as constituent component of structural adjustment programs and the control and containment of prevalent diseases like HIV/AIDS, malaria or tuberculosis has led to the fact that the problem of infertility, which entails distinct gender differences, remains largely un-addressed and assisted reproductive technologies [ARTs] are not considered an option in low resource countries.

The paper focuses on the therapeutic itineraries of involuntarily childless women in urban Kenya. The availability of biomedical options to treat infertility, inclusively ARTs, is determined by the convergence of local and global flows of drugs, technologies, and discourses being conceptualized as a global assemblage. The first paragraph highlights how local and global discourses on (in)fertility have continued to influence material and discursive relationships in the global therapeutic economy. The second paragraph focuses on the definition of infertility in global health agendas in an ethnographic comparison with local concepts of the inability to bear children and coping strategies. The third paragraph outlines how ARTs as globally circulating phenomena have been implemented and conceived in urban Kenya and what responses and tactics have been triggered with a particular focus on biosociality as a new sphere and way of creating connectivity and disconnectivity between the "Global North" and the "Global South".

Negotiating medical knowledge in South-South-Cooperation: The Cuban medical 'mission' in Rio de Janeiro's urban peripheries

Author: Maria Lidola (Universidade Federal do Rio de Janeiro)  email

Short Abstract

The paper explores the current Cuban medical "mission" in Brazil's peripheries by examining Brazilian and Cuban perspectives on public health in their divergent national discourses and local practices, their efforts of alignment and delimitation to the Global Health dispositif of the Global North.

Long Abstract

One year prior to the FIFA World Cup 2014, protests occurred all over Brazil, criticizing the government's extraordinary investments in the forthcoming championships. Instead, people on the streets claimed more investments in education and a "FIFA-norm" public health system. Shortly after, in August 2013, the Brazilian government adopted the "More-doctors" health program as direct response to the protests. Central to this program is a treaty between the Cuban and Brazilian government, comprising the temporary assignment of more than 10.000 Cuban physicians, sent to work in urban and rural peripheries throughout Brazil. Thereby, the treaty is one further outcome of close Cuban-Brazilian international cooperation since the last 12 years of Workers Party's government in Brazil. At the same time, it is part of the Cuban international medical "missions", sent to more than 60 countries throughout the Global South within the last 50 years.

The paper takes a closer look at this specific South-South cooperation, by examining the Brazilian and Cuban perspectives on public health in their divergent national discourses and local practices, their constant efforts of alignment as well as delimitation to the Global Health dispositif of the Global North. Based on ethnographic fieldwork in one of Rio de Janeiro's newly established "family clinics" situated in the favela Complexo do Alemão, the paper pays special attention on daily negotiations between Cuban physicians and their Brazilian colleagues regarding professional recognition and medical knowledge. I will show that these encompass issues of race, gender, nationality and class.

From coastal to global: The transnational circulation of Ayurveda and its relevance for Indo-African linkages

Author: Caroline Meier zu Biesen (Cermes3 (Centre de recherche médecine, sciences, santé et société, Paris)  email

Short Abstract

This paper critically explores the expansion of India's healthcare interventions in Africa with regard to Ayurvedic medicines in Tanzania, as they are framed in the context of an "Indo-Africa renaissance" and "South-South" development cooperation.

Long Abstract

Driven by long-standing ties with India, and closely intertwined with global market interests, a dynamic nexus of medical supply is currently found in Tanzania. To compete at a global level - and framed within the language of "South-South development cooperation for mutual benefit" (Modi 2011) - India appears as the "genuine" exporter of medical products suitable for African clientele. India is thus transforming healthcare practices, with the aim of improving the lives of potential patients (Duclos 2014). The expansion of India's medical sector into Africa is particularly relevant for Indian-manufactured Ayurvedic pharmaceuticals. Mass-produced for a cosmopolitan clientele, these new 'traditional drugs' have become an important element in the global governance of health (Gaudillière and Pordié 2014).

By taking the flow of Ayurvedic medicines to Tanzania as a case study, this paper aims to contribute to the understanding of medical practices as they are configured by the dynamics of global mobility. It explores to what extent the industrialization of Ayurveda occupies a "strategic position" in Indo-African discursive practices and the creation of new market opportunities for India. Moreover, it interrogates to what extent new "South-South" cooperations between Indian and Tanzanian agents give rise to relations of power 
(e.g., for the Indian government by rehabilitating "local health traditions", for traders by reinventing Ayurvedic remedies as a form of "alternative modernity", for the Ayurveda industry by stabilizing new drug formulas for global acceptance, for the Tanzanian government by formalizing Ayurveda within the framework of "professionalization" covered by national policies).

Therapeutic geographies of war: the medical travel industry in Lebanon following the US invasion of Iraq

Authors: Neil Singh (American University of Beirut)  email
Anthony Rizk (Durham University)  email
Omar Dewachi (American University of Beirut )  email

Short Abstract

This paper describes the emergence of a medical travel industry between Iraq and Lebanon that has been contingent on a political economy of care, involving the systematic dismantlement of public health care in Iraq, on one hand; and the expansion of privatised healthcare in Lebanon, on the other.

Long Abstract

War affects the health of populations, and the healthcare systems they navigate, in profound and lasting ways—reconfiguring 'therapeutic geographies' (Dewachi et al., 2014). This paper explores the social, medical and financial consequences of the US invasion of Iraq on Iraqi civilians. We describe the emergence of a medical travel industry between Iraq and Lebanon that has been contingent on a political economy of care made possible by the systematic dismantlement of public health care in Iraq, on one hand; and the expansion of privatised health care specifically geared towards regional medical travellers in Lebanon, on the other. We use a mix of methodologies—both ethnographic and quantitative—to investigate the outsourcing of healthcare to Lebanon, where Iraqi patients in need of care are routinely sent for treatment. First, we relate ethnographic data from interviews with Iraqi patients and their doctors, tracking the stories and experiences of medical travellers as they negotiate questions of biological and therapeutic citizenship in the Arab world. We then juxtapose this with with clinical data from over 6000 Iraqi medical travellers who sought healthcare in Lebanon between 2003 and 2013. Together, the stories and statistics concerning the mass movement of Iraqi patients across national borders—and the disfigured health systems they encounter—tell us much about the ripples of neocolonialism in the Middle East, and the enduring embodiment of war. This research reminds us that wars are not only destructive, but also productive—not just in the movement of capital and people, but also in the formation of new therapeutic subjectivities.

Comparison of global health infrastructure, thick and critical

Authors: Sung-Joon Park (Leipzig University)  email
Rene Umlauf (Bayreuth University)  email
Ulrike Beisel (University Halle-Wittenberg)  email

Short Abstract

This paper approaches the mobilities of and connections between things, knowledge, and people as an infrastructure. We focus on infrastructural fragmentations characteristic for global health and approach these fragmentations through „thick comparison“

Long Abstract

In our paper we aim to reconstruct mobility and connectivity as problems of global health infrastructure. Drawing on recent scholarly debates on infrastructure we approach connections between and mobility of things, knowledge, and people as characteristics of infrastructure of care. Our paper is based on our research on HIV treatment, Malaria treatment, and health systems in Uganda. We are particularly interested in the fragmentations of public health services created by the vast number of projects. The main part of our paper argues that infrastructural fragmentations do not only undermine reliability of data and stability of institutions expected from the provision of care. Instead fragmentations underwrite that context - usually defined in terms diseases, populations, or regions - does not exist independently. Contexts are produced and comparison needs to provide an understanding of the production of fragmentation itself. To fully understand these fragmentations we first propose to examine how practices of infrastructuring shape new forms of mobility and connectivity. Here, infrastructuring captures how people insert agency into the techno-bureaucratic apparatus of global health by creating an own infrastructure of care under conditions of uncertainty. Secondly, we approach the diversity of practices of infrastructuring as an object of "thick comparison" (Scheffer and Niewöhner 2010). Following Scheffer and Niewöhner we understand a thick comparison as a contribution to the theory of comparison. To situate our account of thick comparison we will review medical anthropological literature on comparisons in and of global health.

This panel is closed to new paper proposals.