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- Convenors:
-
Tim Allen
(LSE)
Melissa Parker (London School of Hygiene and Tropical Medicine)
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- Format:
- Panel
- Sessions:
- Friday 21 January, -
Time zone: Europe/London
Short Abstract:
This panel explores how and why ignorance is maintained and institutionalised in the domains of global health and medical humanitarianism. Effective strategies for challenging this state of affairs, and the possibilities of developing ethnographically-informed policies will also be considered.
Long Abstract:
Engagement with evidence in the domain of global health and medical humanitarianism is contingent on agendas shaped by compelling and morally-imbued rhetoric. Saving strangers, ending poverty, eliminating diseases are all linked to pervasive assumptions and assertions about goals and achievements that are often at odds with ethnographic observations on the ground. Although the dissonance is striking, ethnographic findings are frequently set aside as if they are hidden or not known. Medical humanitarians who claim that they are assisting those most in need are, at one level, well aware that they only help some of those they can reach, and challenges, such as the need to preserve their own well-being, acutely constrain what they actually do. Similarly, global programmes, such as the mass distribution of tablets for controlling parasitic diseases fail, but are still promoted as if they are a magical solution to the suffering of the World's poor. Those involved in aid agencies, international organisations, and schools of public health commonly ignore what they know to be true, perhaps because intentions are considered more important than results. However, the way in which evidence is deployed and contained is also part of the story. Medical journals persistently publish articles that deploy data in ways that hide or obfuscate realities. That is partly because hierarchies of evidence set aside anthropological observations in favour of purportedly more scientifically robust numbers. Yet almost everyone is aware that those numbers are used to produce the needed outcomes to sustain existing strategies.
Accepted papers:
Session 1 Friday 21 January, 2022, -Paper short abstract:
The paper will explore how various stakeholders including policy makers in Uganda deploy power, the art of not knowing and strategic ignorance when tackling epidemics in Uganda.
Paper long abstract:
Uganda has a rich history in preparing and tackling disease epidemics including ebola, malaria and cholera. An emergency and humanitarian crisis framework is evoked whenever Uganda is anticipating or experiencing such virulent and deadly diseases. For instance in 2000/2001, some humanitarians and development partners managed the ebola crisis in a war-torn northern Uganda. When a country like Uganda declares a state of emergency due to a disease threat, it means that it will relinquish its power to contain the situation to humanitarians, development partners and pharmaceutical companies. In Uganda the preceding stakeholders have found a niche at the National Emergency Operation Centre to design strategies and intervene in anyway they deem fit. Our fourteen months ethnographic data suggests that various stakeholders have resorted to the art of not knowing and strategic ignorance to tackle disease threats. Although the approach makes their work manageable, villagers view their activities as detached, irrelevant, contradictory and inconveniencing. We argue that disease response mechanisms focussing on one-disease at a time, and a preference for quick fixes, medical technologies and promoting awareness through colourful posters amount to a reactionary response, are unsustainable and too costly for low-income settings. It is better to ensure health systems strengthening for future efficacious epidemics containment and response.
Paper short abstract:
Using autoethnographic methods and qualitative interviews, we explore how South Sudanese humanitarian researchers, during the COVID-19 pandemic, have navigated the often contrasting moral and epistemic worlds of their humanitarian organisations, their own communities and academic institutions.
Paper long abstract:
We draw on our own experiences and interviews with South Sudanese colleagues to explore how South Sudanese who are both humanitarians and academic researchers navigate contradictory moral and epistemic assumptions.
The majority of humanitarians in South Sudan are South Sudanese, working either for South Sudanese or international NGOs. These South Sudanese humanitarians often find themselves caught between the moral framings of the global humanitarian system and the, often contrasting, moral framings of their own communities. On an everyday basis they have to reconcile through practice these conflicting assumptions and pervading dissonance. These everyday practices include hiding certain systems of knowledge. The humanitarian response to COVID-19 was a visible example of the struggles to reconcile global pressures to prioritise the COVID-19 response against South Sudanese prioritisation of other diseases and dangers. Needing to constantly navigate legitimacy among communities and donors, they used various strategies to maintain their respectability and believability.
At the same time, there are a specific group of South Sudanese humanitarians who not only engage with these daily navigations but who also work on ethnographic and qualitative research projects. Research provides alternative routes to navigate these dynamics of dissonance. At the same time, it pulls these researchers into the additional moral and epistemic worlds of academic research. We will draw on discussions with these researchers to allow us to critically reflect on ethnographic and humanitarian production of knowledge and moral framings in times of crisis.
Paper short abstract:
This paper presents a case study from Palabek Refugee Settlement, northern Uganda, to describe when and why humanitarian actors pay attention to counting (or not counting) the movement of refugees and cases of COVID-19.
Paper long abstract:
On a warm September morning, I sat surrounded by brightly branded humanitarian polo-shirts in an inter-agency meeting in Palabek Refugee Settlement (PRS) northern Uganda, my PhD field-site. In this paper I present a case study of this meeting, describing when and why differing pictures of refugee movements are made visible in humanitarian reporting, and when and why attention is paid to counting (or not counting) COVID-19.
Uganda’s ‘open door policy’ for refugees has been complicated by COVID-19. During this time international borders and reception centres have been officially closed. In PRS, however, refugees, continue to arrive. Utilising ‘porous borders’ from South Sudan, they make their way to the settlement. Humanitarian and national actors are tasked with providing mandated care to ‘new arrivals’, registering them as refugees, whilst considering the ‘risks’ of COVID-19 transmission associated with the movement of people. At specific points, decisions to count are made: refugees are registered, screened for COVID-19, and cases quarantined. Until formal processing, however, their presence in the settlement and implications for COVID-19 transmission, remain absent in official reporting.
‘Settled’ refugees in PRS continue to make regular (usually unofficial) journeys to and from South Sudan, for farming, economic opportunities, or personal relationships. These movements, however, are difficult to acknowledge officially, going against UN regulations, so remain absent, or minimised, in official narratives. COVID-19 relating to these journeys is rarely directly counted in the same way as with ‘new arrivals’, but rather, ignorance to this movement - in official rhetoric at least - is maintained.
Paper short abstract:
We explore the social impacts of 'objective' testing interventions throughout successive, layered epidemic crises along Uganda's western border.
Paper long abstract:
Scholars have noted the obsolescence of health metrics, particularly during epidemic crisis, where testing is restricted to particular spaces and risk groups. In this paper, we move beyond the limitations of epidemiological statistics, to consider the social lives of purportedly ‘scientific’ measures and explanations of disease origin and evolution. We present a historically-grounded and ethnographically engaged argument grounded in local responses forged through successive epidemic responses (HIV/AIDS, Ebola, Covid-19), supported by empirical analyses from sites situated along the western border of Uganda. We explore social responses to the production of ‘risk groups’ through testing metrics during the panic of these health emergencies. We argue for a recognition of the social power of epidemiological data, in the absence of public officials willingness to acknowledge uncertainty and ignorance. We comment too on the dissonance between expert attempts to isolate ‘risk groups’ and local strategies to contain epidemics in the region, the latter of which tend to occur within concurrent ‘othering’ of social classes en masse.
Paper short abstract:
Involvement in global guidance on homecare for COVID-19 provides the basis for reflection on the ways in which the idea of ‘best practice’ advice can function to uphold ideals for public health action, deflecting attention from inconvenient truths about contexts where implementation has to occur.
Paper long abstract:
Early in the COVID-19 pandemic, the WHO issued guidance on disease management, focused on key priority areas. As a member of a social science expert group, I was involved in revising the guidelines on homecare for people with COVID-19. The original document, based on MERS coronavirus outbreaks, assumed capacity for testing and recommended hospital isolation of all positive cases. Homecare was sanctioned if this scenario proved impossible, and then only for mild disease. The availability of high-grade protective equipment, water and waste disposal was assumed. Advocating for adaptations to this text involved arguing for the salience of qualitative research that pointed to the likelihood that COVID-19 was being experienced in contexts where testing was unavailable, where access to healthcare was limited and where informal providers and/or kin would be caring for potentially very ill people in single-roomed houses, with limited resources. A related experience involving wider consultation with humanitarian practitioners on the provision of pragmatic advice for homecare in such circumstances surfaced discomfit in some quarters with formal guidance that might be seen to advocate for less-than-ideal practice, and even the view that such an endeavour was unethical and tantamount to accepting inferior standards of care for people in low-income settings. I will reflect on this process and the ways in which the idea of standardised ‘best practice’ advice can function to uphold ideal scenarios for public health action, thus deflecting attention from inconvenient truths about the inevitable messiness of real-life, resource-constrained contexts where measures have to be implemented.