Paper short abstract:

This research examines a NGO focused on bone marrow transplant donor recruitment in South Africa, and how their instantiations of promise in policy and practice marshal a combination of race and class, immunogenetic compatibility, post-Apartheid political exigencies, and biomedical technology.

Paper long abstract:

South Africa's constitution promises all citizens access to health care. Actual service provision, however, remains unequal along lines of class and race. The uneven distribution of health care resources is evident in the case of expensive, clinically risky treatments that benefit a small number of patients. Nonetheless, advocates for such procedures, particularly privately funded NGO's, thrive and garner public attention. How are they able to do so in the face of the unfulfilled promises of post-Apartheid racial equality and universal health care access? To grapple with this question, I focus on the case of bone marrow transplantation, a treatment for leukemia and blood disorders requiring highly specific immunogenetic compatibility. I conducted fieldwork with the Sunflower Fund, a NGO with the mission to recruit bone marrow transplant donors for South Africa's donor registry. Despite the still-limited provision of bone marrow transplants, the Sunflower Fund leverages instantiations of promise to make an appeal for their work. I focus on three examples:

1) Promises of middle class aspiration and greater wealth/health through post-apartheid economic policies and practices that validate corporate interests and privatization.

2) Hopes of racial diversity and class values among other factors as tools for calculating biomedical risk, immunogenetic matching and bio-civic inclusion/exclusion.

3) Historic and ongoing investment in bone marrow transplantation as a procedure endowed with salvific promise.

Through an examination of promise in this context, I demonstrate the extent to which the rhetoric and practices of aspiration and hope often supersede the scrutiny of actualized outcomes and critical reform.