Paper short abstract:

In 1993, WHO proclaimed tuberculosis to be a global emergency to be attacked through the so-called Directly Observed Treatment, Short Course strategy. This paper will discuss the links between history and memory in the advent of the DOTS strategy looking at the cases of East Africa and India.

Paper long abstract:

In 1993, in the context of the HIV epidemics, WHO proclaimed a global tuberculosis emergency necessitating so-called Directly Observed Treatment, Short Course strategy. Subsequently DOTS became a major component of a global health enterprise, providing solutions to health challenges in Southern countries. Paradoxically, DOTS is not innovative in any biomedical sense but offered a new organizational framework built around older medicines and diagnostic tools.

Looking at the inception and development of the strategy in India and East Africa, this paper will argue that DOTS is a powerful lens to address a rarely discussed dimension of global health: the return of "vertical" programs after a period of eclipse in the 1970s and 1980s,. This return could appear as innovative because the memory of (failed) enterprises like malaria eradication had faded away, because tuberculosis had disappeared from the agenda, and because new actors in global health strongly promoted disease-centered therapeutic initiatives.

We will discuss the links between history and memory in the advent of the DOTS strategy in two ways. The case of East Africa it will show how the medical experts in the 1980-1990s mobilized the history of tuberculosis control to design the new strategy. The case of India the implementation of a "Revised National Tuberculosis Program" based on DOTS, will explore the juxtaposition of a strong critic of the past (the "old" National Tuberculosis Program from the late 1960s onward) and of continuities in TB management in India.

Paper short abstract:

Diverse actors have tried to tackle sleeping sickness in Southern Sudan. The absence of a central authority hampered learning and planning in disease control work, tasks that were further complicated by fluctuations in the dominant actor types during different phases of the conflict.

Paper long abstract:

This paper explores how a range of actors have tried to control Human African Trypanosomiasis (HAT; commonly known as sleeping sickness) in Southern Sudan between 1955 and 2005. In this period, Southern Sudan experienced two prolonged civil wars, interspersed by a period of post-conflict reconstruction. Over this period of conflict and calm, the types of actors and modes of engaging in humanitarian work changed considerably. Today, the region is one of the most impoverished and weakly governed in the world.

HAT control in Southern Sudan is a case study in tackling an infectious disease in highly adverse circumstances. We explore this history through extensive archival research and interviews. We argue that the absence of either a capable government or dominant external actor to organise and coordinate had profound consequences. Without either a clear evidence base or a shared understanding of previous strategies, actors were prone to adopting idiosyncratic methods that reflected their own organisational priorities. For instance, recurring debates over both competing disease control techniques and the viability of eliminating HAT entirely were clouded by problematic interpretations of the past.

Ultimately, these successive cycles of forgetting and highly selective remembering of past projects highlight the limitations of twentieth century humanitarianism. It is a truism that development, humanitarian, and global health organisations often fail to learn from the past: the case of HAT in Southern Sudan exemplifies that tendency, as well as the broader difficulties of coordinating external actors with diverse methods and motivations.

Paper short abstract:

Drawing on the official records of past Executive Board and World Health Assembly meetings, the paper will reflect on the contemporary rules and practices, which where observed (or otherwise noted) in the course of an on-going ethnography at these core sites of WHO's annual policy cycle.

Paper long abstract:

The paper will reflect on the contemporary (policy-making) rules and practices, which where observed (or otherwise noted) in the course of an on-going ethnography at the core sites of WHO's annual policy cycle - at Executive Board and World Health Assembly meetings in particular. This will bring some historical depth to the synchronic ethnographic account and promises furthermore to produce insights that can be used for constructive criticism in the contemporary debates on WHO reform, which include discussions about the reform of WHO's governance bodies.

In order to reconstruct the historical rules and practices, the paper draws on the official records (e.g. verbatim and summary records) of past meetings of the Executive Board and of the World Health Assembly at which the desirability of changing the then current rules and practices was discussed. Overall, the paper attempts to tease out how stable the rules and practices have proven and how contested/accepted they appeared over time. This includes a discussion of the following questions in particular, which are also hinted at in the paper title: What problems of the WHO governance bodies where identified in the past and what (positive) alternatives where envisioned for the future? Have these discussions changed over time or do the governance bodies still face "the same" problems? Finally, what contemporary rules and practices are the (un)intended consequence of past reforms?

Paper short abstract:

This paper contrasts the mechanisms by which the scientific and cultural lives of disease control have been rendered in/as memory at a medical site of one-time global renown, the Leprosy Centre, Uzuakoli, Nigeria.

Paper long abstract:

The records of past scientific endeavour at the Leprosy Centre, Uzuakoli, where much of the key experimental work underpinning today's treatment regimen was carried out, have been of little interest to embattled successive medical administrators, grappling with the chaos of post Civil War and post structural adjustment public health. The constrained horizons thus constructed around medical activity, its spaces and temporalities, and its histories contrast with the echoes and resonances of song and music - relating to the life and work of former patient Ikoli Harcourt Whyte - for which the Leprosy centre is much more greatly renowned in Nigeria. Contrasting experimental practice and musical culture - paper records and shared songs - as roots of memory and commemoration, this paper interrogates the fate of science in the aftermath of promise, demonstrating a surprisingly robust cultural legacy of the experience of science and therapy, even as the records of scientific progress lie ruined.

Paper short abstract:

In 1960s Kenya, public hospitals projected a vision of civic entitlement and medical modernity. Today they remain as ambivalent materializations of both progress and decay. I attend to efforts, amidst this ambivalence, to reach for a public health in an era of privatization and growing inequality.

Paper long abstract:

In 1960s Kenya, progressive dreams of a postcolonial public health focused on health infrastructures, the most impressive being the building of modern, state-of-the-art public hospitals. These solidly built structures materialized an anticipated future, of medical modernity, public service and a modern state, and an associated civic politics of entitlement, obligation and belonging. Fifty years later, these buildings remain - ambivalent symbols of past utopias and present dystopias, materializations of both progress and decay. This paper engages with this ambivalence. When medical progress, public hospitals and the state no longer cohere, people reach for the future through other means. I attend to efforts to remember and reach for a public health in an era of global health, privatization, and increasing inequality.

Paper short abstract:

I examine recent formation of Korean maternal health services in Ethiopia as an exercise to rewrite histories of both donor and recipient of global health. I explore the ways in which historical memories of war, developmental state, and religion helped foster these new forms of care in Ethiopia.

Paper long abstract:

During the Korean War, Ethiopia dispatched six thousand soldiers to fight on behalf of the South. Today, the primary trope of Korean development assistance in Ethiopia is "paying back the historical debt of the Korean war." International health programming is a moral act of care, but might it also be means for managing the past and imagining the future? To Korean aid workers, Christian medical missionaries, family planning and rural development projects in Ethiopia bring memories of mass mobilization under the Korean developmental dictatorship in the 1970s. The incumbent government in Korea, headed by the daughter of the former military strongman, aims to invoke memories of the Korean War and heydays of military dictatorship through global health projects. In 2010, a Korean maternal health center was built in a rural town, Itheya, Arsi Zone, Ethiopia. Near Itheya center sits the Aanolee Memorial Monument, a statue of an amputed arm holding a severed breast. It stands to memorialize the Oromo people who were mutilated and humiliated by the conquest of the Menelik II after years of fierce resistance in 1886. Itheya is a birthplace of pan-Oromo national movements where hundred thousands Oromos gathered in 1966. Since then, Arsi Oromo peasants have been the primary target of a foreign aid-funded agricultural development and forced villagization. This research examines multiple layers of histories in conflict for rewriting spaces of experiences in pasts and horizons of expectations through global health with the case study of Korean maternal health project in Ethiopia.

Paper short abstract:

This paper charts the unbuilding of several East African laboratories, intertwined with the life of the scientist who worked in and sought to re-work them (1960s-80s). Attending to post-colonial ‘Africanisation’, reconstructing an exceptional story of hope and failure, it sheds light onto the lasting double-bind of universal promise and material inequality in today’s African ‘global health’ science.

Paper long abstract:

In 2015, medical science in Africa remains riddled with questions of ownership and priorities, collaborative justice, and the transfer of capacity and authority. Half a century ago, these concerns were addressed as ‘Africanisation’, a visionary project, and a practical and administrative challenge. Africanisation, and subsequent attempts at creating African science remain present, often as present absences – forgotten, hidden, occasionally remembered – in ‘global health’s’ ongoing struggles with scientific and political-economic inequality.

This paper examines one moment of 1970s Africanisation by tracing the unbuilding of an African laboratory (1950s-1980s) – not just metaphorically but by attending to purposely erased and projected but unbuilt scientific edifices in Kenya and Tanzania, that are linked by the biography of Dr W, the Kenyan scientist who learned and worked in them, dreaming of and engendering transformations.

It begins with an old research station in Tanzania where Dr W was trained and assisted British scientists. Later, as the famous station's first African director, he demolished his laboratory to build a modernist multi-storey institute befitting a new scientific Africa. It was never built, but Dr W took this project for a new, national laboratory back to his native Kenya, where he planned a science city away from the city, with laboratories, housing and social infrastructure. Yet, before construction began, Dr W was hospitalised with a psychiatric disorder. After his release he established, with his wife and technician, another small laboratory, first in a rented room, then in a semi-permanent building at home, and continued experimenting with medicinal plants, until he died.

The paper charts a biography of loss: of projects and hopes, as well as of capacity and infrastructure. From the abandonment of a globally networked laboratory built for imperial eternity, to the disappearance of an ephemeral mud-building surrounded by hopes for an African science. At the site of the latter, a wooden signboard: 'Manyasi (trad.medicine) African Science Research Foundation', emblazoned with the (Tanzanian) symbol of African socialism, is al that remains, under a stack of firewood: a monument to one instance when a different African science had been imagined, before it was discredited as mere dream: unrealistic aspiration without material basis, misguided refusal of 'universal' scientific excellence - or, as in this particular case, pathology.

While Dr W’s tragedy is exceptional, its pathology resonates with Franz Fanon’s diagnostic meditations on schizophrenia. Drawing on Gregory Bateson’s work on this medical problem, remembering this biography brings to our attention the ‘double-bind’ of inequality and universality, domination and freedom, which remains at the heart of global public health science.

Paper short abstract:

Health scientists and historians encounter the debris, reversals and opportunities that form in the wake of changes in plausibility. This paper explores the survival of three abandoned dreams of (inter)national public health amid a reopening of futures in the time of global health in Senegal.

Paper long abstract:

In 1966, Pierre Cantrelle announced a near future of accurate and comprehensive vital registration in rural Africa. In 1974, a proposal for a national medicinal plant research institution written by Joseph Kerharo was approved by the Directorate of Scientific and Technical Research. In 1973, Georges Gras suggested the creation of a national poison control centre to the Senegalese authorities. 

Decades after they never happened, these plans remain present as (im)possible futures on old paper, in jokes, regret, hope and celebration, or in new and ongoing visions of global health intervention and research. As these futures, as plans, vanish for those who awaited them, and for historians leafing through records, what becomes of this archive of the plausible? Is it a reminder of past and future possibility, or does it break up into forgotten fragments and residue of the utopic? And what should one make of recent echoes and revivals of past developmental plans in the time of global health? 

Paper short abstract:

The town of Kalakol has some of the worst health indicators in Kenya. Healthcare here is symptomatic of marginalization and a history of failed development plans. I show how past interventions still inform the agendas of current health strategies and how their rhetoric has changed since the 1980s.

Paper long abstract:

In Turkana, Kenya, new incarnations of global health coincide with remains of past development plans. The scant health system in the district is symptomatic of marginalization and repeated failures of development projects, most of which conducted by the Norwegian Agency for Development Cooperation (NORAD) in the 1980s. During this decade, NORAD achieved an amelioration of the healthcare system in the region. Unfortunately, sudden end to NORAD´s collaboration with the Kenyan Government concluded several promising initiatives. Whilst the 1980s saw a brief improved healthcare situation, other development plans with the fisheries forced relocation and sedentarization upon Turkana pastoralists. With NORAD´s withdrawal, many Turkana became poorer and moved into larger towns, leading to quick spread of HIV/AIDS, one of many disastrous health consequences. In Kalakol, on Lake Turkana, the allure of fishing development attracted thousands of dispersed people. Here population is still growing whilst the overall health and economic situation is worsening. Since the 1990s an insufficient and rudimentary healthcare system is maintained only by religious organizations and NGOs.

My paper compares past health and development documents with recent ones: NORAD health reports with those of religious missions and the Kenyan Ministry of Health. What is left of past development plans in present health strategies? How have major health challenges changed and what are the plans to overcome them? Has the rhetoric of intervention changed?

My paper answers these questions based on observations gathered during fieldwork in 2009, focusing on Kalakol as example of failed experimentation of grand-scale developmental plans.

Paper short abstract:

Historical ethnography in Guyana draws attention to strong continuities between reforms under cooperative socialism and structural adjustment, encouraging us to revisit our origin stories and tales of neoliberalism in health.

Paper long abstract:

Today's anthropological literature remembers structural adjustment projects of the 1980s as a key turning point in the decline of public health services and the rise of neoliberal health policies in much of the world. However, historical ethnography of health system reform in Guyana reveals a picture of continuity much more than change associated with structural adjustment. In this paper I argue that the origin stories we tell of neoliberal reforms risk constructing international financial institutions as villains so pure that they obscure our vision of what came before, and of the context within which reforms have come into being. Tales of user fees, frozen salaries, and private insurance instituted under loan projects sit uncomfortably with the story that emerges from ethnographic research with healthcare workers in Guyana and the documentary traces produced by health programs in the 1980s and 90s. In some cases this is because the "hollowing out" of the health system had begun much before structural adjustment, especially as Guyana was cut off from international funding under its cooperative socialist regime, in other cases it is because health professionals fought to keep "international best practices" from being instituted here. These stories highlight that financial institutions have not been all-powerful, and instead draw attention to the specific negotiations of Guyanese healthcare workers and the health system within which they worked.