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.