Short abstract:

In Tanzania, cancer is a lens to observe various scales of epistemic absences. Based on ethnographic data in urban Tanzania, this paper explores epistemic absence by focusing on the experiences of providers, intermediaries, and patients, asking what is at stake when cancer palliation becomes care.

Long abstract:

Today in Tanzania the National Cancer Control Strategy estimates that only 10% of cancer cases reach the referral level and over 80% of these cases arrive in late stages. [Tanzania National Control Strategy estimates]. In this context of palliation as care, cancer becomes a lens to observe various layers of epistemic absences and how they unfold at various scales or social contexts. These absences in Tanzania entail not only the lack of diagnostic and therapeutic technologies and medicines but also extend to gaps in the knowledge and understanding of the roles and experiences of health providers, traditional and spiritual healers. Based on ethnographic data conducted at a national cancer hospital in Dar es Salaam and communities in Bagamoyo, Tanzania in 2021 and 2024, this paper explores epistemic absence by focusing on the experiences of providers, their intermediaries, and patients. We ask, how do health workers, patients, and family members make do, talk about, and experience cancer? How do political, technological, and sociocultural silences surrounding cancer shape what practices count as care, and in turn how do existing care practices inside and outside of biomedical health facilities shape local lexicons and possibilities for cancer prevention and treatment? In what ways is cancer rendered as biomedical, social, and technological? Where and how can cancer be treated in individual bodies, communities, and environments? We seek to transform the study of cancer in Tanzania by centering these epistemic absences, their imaginaries and limitations, asking what is at stake if they are not urgently addressed.