Paper short abstract:

In this paper we explore the geo-political, ethical, social and technical issues that followed in the wake of a laboratory established in Nepal to screen Bhutanese refugees being relocated to the US.

Paper long abstract:

Drawing from ongoing research into the role of laboratories in TB control, this paper focuses on a laboratory established by the International Organisation of Migration (IOM) - an intergovernmental organization - in Eastern Nepal. Supported by the CDC, its primary purpose is for the screening of refugees. From the 1990s, following a process of ethnic cleansing in Bhutan, over 100,000 Bhutanese of Nepalese origin migrated to Nepal and were housed in refugee camps. In 2007 the U.S. announced that they would offer settlement to most of those remaining in the camps in Nepal. The state-of-the-art lab was installed near the camps to screen (and then treat) infectious diseases, in particular tuberculosis, in the refugees prior to resettlement. However, these services are far superior technically and medically than those provided to the surrounding population through the Government of Nepal Primary Health Care setup and it National Tuberculosis Programme, and were dependent on policies and practices developed by the CDC. Aware of this medical, ethical and political dilemma, the IOM started to draw up protocols for greater "harmonization" with local services, and to support local laboratories through the provision of GeneXpert machines, a new technology, recently sanctioned by the WHO, used for speeding up the diagnosis of TB. In this paper we explore the geo-political, ethical, social and technical issues that followed in the wake of this complex assemblage, to pose questions to current thinking around the emergence of ideas to what makes up "global health".