Paper short abstract:

The rise of global health interventions designed in and directed from the North has led to increased demand to data gathered and produced in the South. This paper will examine the multiple stakes of conducting research for Haitian clinicians.

Paper long abstract:

The rise of global health interventions designed in and directed from the North has led to increased demand to data gathered and produced in the South. This increase has in turn led to increased pressure on and incentives for clinicians in resource-poort settings to conduct research. Based on an ethnographic study conducted in Haitian universities and hospitals between 2013 and 2016, this paper will examine the multiple stakes of conducting research for Haitian clinicians. I will describe how research conducted by Haitian clinicians offers not only the promise of improved health programs and services for Haitian patients, but also the potental for professional advancement and by extension, opportunities for emigration for the Haitian clinicians themselves. The transnational movements of research methods and ways of knowing have crossed certain boundaries but have also created and reinforced others. Understanding them is essential to developing critical and engaged perspectives on global health, health inequalities and resource disparities.

Paper short abstract:

The presentation attends to the ways a participatory framework called “Theory of Change” (ToC) operationalizes (and perhaps challenges) the paradox between universality and contingency within a multi-country research consortium in Global Mental Health.

Paper long abstract:

The movement for Global Mental Health (GMH) is a multi-disciplinary assemblage striving to treat 'mental health' on a global scale through evidence-based interventions. While relying heavily on standardized epidemiology to advocate for mental health in the policy arena, GMH's treatment models and clinical trials often employ flexible and iterative research designs that square the demands of a globally comparable data production with the contingencies of situated knowledge and health systems. Drawing on empirical fieldwork within a multi-country mental health research consortium, this presentation attends to the ways a participatory framework called "Theory of Change" (ToC) operationalizes (and perhaps reformulates) the paradox between universality and contingency in practice. "Theory of change" workshops reverse-engineer a desirable outcome by inviting a number of stakeholders to collectively define the process and steps required to achieve it. The resulting "ToC maps" can vary greatly from country to country, yet they create the language, conceptual skeleton and, importantly, new spaces of indeterminacy, through which knowledge emerges, flows, and temporarily hardens for the sake of global comparison. By paying attention to ToC as a space and practice that is neither "global" nor "local" I seek to trouble the common narrative of how universal categories, metrics and modes of accounting come up against "local" realities "on the ground".

Paper short abstract:

This paper explores the processes through which attempts to mobilise a globalised vision of human rights in mental health care are translated, adapted and resisted in the situated practices and reflections of health workers in Ghana.

Paper long abstract:

This paper explores the processes through which attempts to mobilise a globalised vision of human rights in mental health care are translated, adapted and resisted in the situated practices and reflections of health workers in Ghana. The WHO, UN and key actors in 'global mental health' have given increasing impetus to the mobilisation of human rights in the treatment of people with mental illness, promoting the adoption of rights-based legislation and policies to combat abuse and ensure access to treatment. In Ghana the discourse of human rights has been enacted within the reform of mental health legislation and the expansion of community-based mental health care and self-advocacy groups, driven by the resources and influence of international agencies, donors and NGOs. At the same time public sector spending has been curtailed and health services receive no dedicated funding for mental health, resulting in severe challenges in delivering quality care. While workers express an overt rhetoric of people with mental illness as 'just like us', in practice there are fears that the enactment of mental health legislation prioritises patients' over workers' rights, particularly since constrained resources jeopardise worker safety. In addition, the moral imperative to maintain relationships and social harmony and the economic and social necessity to retain the family as care provider is mobilised against the prioritisation of individual rights and the use of legal compulsion. Through such debates health workers expose the political, economic, social and ethical concerns which trouble the smooth translation of human rights in mental health care.

Paper short abstract:

Based on data from an ongoing multi-site ethnography, the aim of this conference is to analyze the recent epistemological changes towards prevention in dementia research. We will show how this international discourse is embedded in both specialized and non-specialized Brazilian sites of care.

Paper long abstract:

Based on data from an ongoing multi-site ethnography, as well as media output analysis in Brazil, the aim of this conference is twofold: the first is a short overview of the recent epistemological changes towards prevention in dementia research and public health recommendations. The second part will show how this international discourse is embedded in different Brazilian sites. Both specialized and non-specialized practices targeting aging individuals will be analysed. Special attention will be paid to the taking of medications versus lifestyle activities in order to prevent dementia, and how these two kinds of practices are entangled, depending on how prevention is being framed.

Paper short abstract:

Microbicides clinical trials provide an interesting site of observation on how biomedical technologies move from the Global North to the Global South. Research with women participating in a trial reveal how such transfers are understood by Global South women.

Paper long abstract:

The development of a biomedical technology depends prevailing medical and political interests and cultural norms (Lock and Nguyen 2010). Recognition of the need to develop a biomedical HIV prevention tool for women arose from a realisation that women face specific difficulties in protecting themselves from HIV. In the 1990s, Global North feminists called for chemical barriers that would be easy to insert in the vagina, undetectable and "women controlled". Microbicide gels were developed with the potential to be a "feminist technology", having a transformative and empowering effect on women's lives. These technologies were also imbued with ideas about women's sexuality linked to risk and vulnerability.

The process of "transfer" of microbicides from the North to the South depends on tinteraction between society and science, and clinical trials provide such interactions. My research was situated in a microbicide trial and explored sexual discourse that surrounded women participants, within and without the trial. Women's accounts focused on hope about the gel and distrust about condoms, and revealed concurrence with the biomedical frame of the study. They understood the concept of an experiment and understood the purpose of the trial within a discourse of women's empowerment, which for them coincided with their own endeavours to seek autonomy in relationships and HIV prevention. The microbicide gel was found to be ineffective in preventing HIV, however, women's motives to join the trial were about knowledge and thus for them the trial itself was described as empowering, despite the outcome of the trial.

Paper short abstract:

This paper explores the production, transformation and movement of evidence collected for a clinical trial. This movement exposes how evidence is differently understood in a variety of settings and the complex relationships forged between northern and southern global health institutions.

Paper long abstract:

Global health is reliant on the collection and analysis of evidence to support interventions. One way that evidence is produced in global health is through clinical trials, whereby rigorous science is deployed in the production of experimental data. Drawing on ethnographic research in northeastern Tanzania, this paper explores the collection, transformation and movement of evidence in a clinical trial for a malaria vaccine. I focus on the procedure of how blood, a main source of evidence in many clinical trials, moves across space and is transformed into information that is trusted and meaningful. Blood is laden with evidence and the transitional meaning of blood, from biological factor, to object of inquiry, to a matter of clinical proof, reveal its differential understandings in the clinic, laboratory and business sphere. For this clinical trial, blood samples were collected from trial participants, transported to a Tanzanian research centre and fragmented into smaller units for analysis, resulting in information about the health of participants. The blood and information gathered were then transported to laboratories and computers outside of Tanzania for further analysis. In addition to tracing shifts in meaning from one setting to another, this paper looks at how the collected blood and information also built credibility through its movement from a research site in the south to reputable centres of science and technology in the north. Through an examination of the flow of blood and data in this clinical trial, I uncover complex, historically-rooted relationships between northern and southern global health institutions.

Paper short abstract:

While scientists and health officials call for radical shifts in vaccine innovation, the business model of industrial vaccine science has taken hold. This paper follows an Ebola vaccine moving from a national publicly funded lab, through its licensing to a small biotechnology firm and Big Pharma.

Paper long abstract:

Endorsed by all 194 Member States of the World Health Assembly, the World Health Organization is now more than mid-way through the Global Vaccine Action Plan to achieve universal access to immunization by 2020. Emerging, neglected and vaccine preventable diseases continue to challenge national, NGO and multilateral efforts to detect, monitor, control and eradicate them across low, middle and high income countries. While public health officials turn to the term "vaccine hesitancy" to explain the reasons and concerns surrounding the loss of public confidence in immunization among some individuals and communities, few have systematically analysed the global industrial vaccine research and development assemblage for clues into scientific and public-private health practices which may be changing the game. The number of vaccines recommended for routine immunization programmes have expanded over the past generation while development, manufacturing, affordability, access and effectiveness must be traded-off in multilateral corporate shell games using technical and political decision-making frameworks dependent often on limited data. At a time when the merging of open-market sources of pharmaceuticals and biologics has allowed the costs of existing health products to skyrocket, few paid attention to the selling of one of the world's last public vaccine facilities. While public scientists and health officials are calling for radical shifts in vaccine innovation science, the business model of industrial vaccine science has taken a firm hold. This paper follows an Ebola vaccine as it moves from a national publicly funded laboratory, through its licensing to a small biotechnology firm and Big Pharma.

Paper short abstract:

This paper questions standardized approaches to mental health care in post-war development contexts arguing that available treatment options rather than symptoms determine diagnoses and care. Normative assumptions about standardization, evidence and ethics will be questioned and critically discussed.

Paper long abstract:

Mental health and psychosocial treatment approaches are increasingly transported to post-war development contexts as part of capacity building initiatives. These foresee the training of local health providers by foreign psychiatrists and psychologists in standardized diagnostic approaches and evidence-based treatment strategies. Underlying this is a well-accepted biomedical logic which assumes that if symptoms are correctly identified, they can be translated into discrete mental disorders, and the disorders into forms of treatment. In this talk, I will turn this logic on its head arguing that in resource poor settings available treatment options drive the establishment of matching diagnoses to which symptoms are then retrospectively assigned. I will illustrate this argument with ethnographic examples Kosovo where the poorly functioning health system and the limited treatment options forced practitioners to frame their patients as predominantly traumatized while ignoring the everyday stressors that affected their mental health and wellbeing. This forceful framing was achieved through a "civilizing rhetoric" that allowed practitioners to cast their patients as ill informed and lacking insight into the causes of their distress. Thereby, diagnostic personas emerged that justified through an argumentum e contrario the application of available psychiatric treatments. Taken out of context such decisions and psychiatric practices appear not only inadequate, but also unprofessional and ethically questionable. Yet, they were not taken in the abstract, but within a context of lack, structural inadequacies and political insecurity all of which, I shall argue, shape therapeutic encounters and possibilities for providing care in very practical ways.

Paper short abstract:

Drawing upon troubles experienced by Google Flu Trends, this paper explores how algorithmic tracking aims to turn a messy, connected world into a searchable space. It pays particular attention to tracking’s relationship to the otherness of viral life, including its social manifestations.

Paper long abstract:

In August 2015, Google shut down Flu Trends, its flagship predictive analytics system specialized in the anticipation of influenza outbreaks. Launched in 2008, Flu Trends used an algorithmic model to track influenza activity based on people's web searches. However, it had its troubles. Put roughly, Flu Trends was susceptible to picking up false signals and overestimate influenza activity. This was particularly the case in times of epidemics, when unanticipated changes in search behavior were triggered by heightened exposure to disease-related information. As a result, whole populations started Googling symptoms they did not have, provoking Flu Trends' overestimation. In times of epidemics, Flu Trends did not reveal the sort of "collective wisdomˮ often associated with online behavior, and algorithms. Drawing upon these troubles, this paper explores algorithmic tracking, and how it turns a messy, connected world into a searchable space. On the one hand, Flu Trends' failure may be seen as one in accounting for the incommensurable otherness of emergent viral life. On the other hand, a lesson to be drawn from Flu Trends' failure is that how it did not have direct access to viral life, and compensated for this, was as important as the lack of access itself. This paper does not seek to elaborate an argument to be applied to all algorithmic tracking systems, but rather aims to examine how Flu Trends speaks to wider relationships — of coconstitution, but also tension, and disjunction — between sensuous participation to collective life, and emergent forms of digital abstraction.

Paper short abstract:

This paper explores how evidence-based guidelines are adapted in practice. More specifically, it is interested with this process as it unfolds in the context of global health initiatives – that is when EB knowledge and guidelines elaborated in the North move to - and are implemented in - the South.

Paper long abstract:

Global health organizations attend to populations around the world applying an evidence-based model of care that often does not correspond with local realities. This paper provides an in-depth anthropological study of how this occurs within practices in and around World Spine Care's (WSC) clinics in Botswana. More specifically I explore how evidence-based knowledge and guidelines are negotiated and improvised on the ground, paying particular attention to the ways WSC volunteers are (un)able to work with local health workers. I show the flows and counter-flows implicated in the difficult task of reconciling skills with standards which leads me to problematize the 'art vs. science' dichotomy. Medical practitioners - WSC's to the least - seem to navigate a space in-between in their everyday work using both 'official' EBM evidence and their own experience to guide their practice that can be described as a creative 'improvised' performance. What appears to be the challenge is to officially recognize this creative process as legitimate, especially when performed by local Motswana health workers. This situation only works to impede WSC's capacity to collaborate with them which conversely appear as an obvious line to follow if WSC hopes to 'adapt their practices to the culture' and to diverse understanding of 'healing'. My suggestion is ultimately to bring our attention to the more or less successful accomplishment of binding practice with protocols - the point is to explore how practitioners (including non-EBM health workers) manage to make these meaningful in practice.

Paper short abstract:

'Best practice' within end of life care is typified in English hospice care. There have been attempts to replicate these practices in different care settings, both within England and other countries. This paper critically examines this movement towards standardisation

Paper long abstract:

End of life care involves the managed care of dying persons, usually within the last few days of life. It is primarily based on palliative care principles and practices . These have been developed since the modern hospice movement was founded in England in the 1960s, which seeks to provide holistic care, not just biomedically-focused treatment.

Acknowledging that end of life care can improve the quality of life, different countries have sough to apply these care practices in other settings. An example of this is the development and proliferation of the Liverpool Care Pathway for the Dying Patient (LCP). This is a document developed to adapt the 'best practices' of hospice care to other clinical settings. In England, it was promoted by national policies and funding strategies to be implemented in all hospitals. It has also been adopted in other countries, for example the Netherlands.

In this paper, we examine how the adoption of the LCP sought to standardise care and the ways in which the movement of knowledge (from hospice to other settings, from England to other countries) shifted the kinds of care that could be possible. Thereby it dictated what should be considered quality of care at the end of life and its use seeks to standardise how death can occur through the management of the dying process. By examining the mobilisation of the LCP, and where this has been challenged and not challenged, we will comment on the extent to which dying continues to problematise medical management.