Para States And Medical Science

In Para-States and Medical Science, P. Wenzel Geissler and the contributors examine how medicine and public health in Africa have been transformed as a result of economic and political liberalization and globalization, intertwined with epidemiological and technological changes. The resulting fragmented medical science landscape is shaped and sustained by transnational flows of expertise and resources. NGOs, universities, pharmaceutical companies and other nonstate actors now play a significant role in medical research and treatment. But as the contributors to this volume argue, these groups have not supplanted the primacy of the nation-state in Africa. Although not necessarily stable or responsive, national governments remain crucial in medical care, both as employers of health care professionals and as sources of regulation, access, and "albeit sometimes counterintuitively - trust for their people. The state has morphed into the para-state " not a monolithic and predictable source of sovereignty and governance, but a shifting, and at times ephemeral, figure. Tracing the emergence of the global health paradigm in Africa in the treatment of HIV, malaria, and leprosy, this book challenges familiar notions of African statehood as weak or illegitimate by elaborating complex new frameworks of governmentality that can be simultaneously functioning and dysfunctional.

In Para-States and Medical Science, P. Wenzel Geissler and the contributors examine how medicine and public health in Africa have been transformed as a result of economic and political liberalization and globalization, intertwined with epidemiological and technological changes. The resulting fragmented medical science landscape is shaped and sustained by transnational flows of expertise and resources. NGOs, universities, pharmaceutical companies and other nonstate actors now play a significant role in medical research and treatment. But as the contributors to this volume argue, these groups have not supplanted the primacy of the nation-state in Africa. Although not necessarily stable or responsive, national governments remain crucial in medical care, both as employers of health care professionals and as sources of regulation, access, and – albeit sometimes counterintuitively - trust for their people. “The state” has morphed into the “para-state” — not a monolithic and predictable source of sovereignty and governance, but a shifting, and at times ephemeral, figure. Tracing the emergence of the “global health” paradigm in Africa in the treatment of HIV, malaria, and leprosy, this book challenges familiar notions of African statehood as weak or illegitimate by elaborating complex new frameworks of governmentality that can be simultaneously functioning and dysfunctional. Contributors. Uli Beisel, Didier Fassin, P. Wenzel Geissler, Rene Gerrets, Ann Kelly, Guillaume Lachenal, John Manton, Lotte Meinert, Vinh-Kim Nguyen, Branwyn Poleykett, Susan Reynolds Whyte

In Para-States and Medical Science, P. Wenzel Geissler and the contributors examine how medicine and public health in Africa have been transformed as a result of economic and political liberalization and globalization, intertwined with epidemiological and technological changes. The resulting fragmented medical science landscape is shaped and sustained by transnational flows of expertise and resources. NGOs, universities, pharmaceutical companies and other nonstate actors now play a significant role in medical research and treatment. But as the contributors to this volume argue, these groups have not supplanted the primacy of the nation-state in Africa. Although not necessarily stable or responsive, national governments remain crucial in medical care, both as employers of health care professionals and as sources of regulation, access, and – albeit sometimes counterintuitively - trust for their people. “The state” has morphed into the “para-state” — not a monolithic and predictable source of sovereignty and governance, but a shifting, and at times ephemeral, figure. Tracing the emergence of the “global health” paradigm in Africa in the treatment of HIV, malaria, and leprosy, this book challenges familiar notions of African statehood as weak or illegitimate by elaborating complex new frameworks of governmentality that can be simultaneously functioning and dysfunctional. Contributors. Uli Beisel, Didier Fassin, P. Wenzel Geissler, Rene Gerrets, Ann Kelly, Guillaume Lachenal, John Manton, Lotte Meinert, Vinh-Kim Nguyen, Branwyn Poleykett, Susan Reynolds Whyte

In the timber plantations in northeastern South Africa, laborers work long hours among tall, swaying lines of eucalypts, on land once theirs. In 2008, at the height of the HIV/AIDS crisis, timber corporations distributed hot cooked meals as a nutrition intervention to bolster falling productivity and profits. But life and sustenance are about much more than calories and machinic bodies. What is at stake is the nurturing of capacity across all domains of life—physical, relational, cosmological—in the form of amandla. An Nguni word meaning power, strength or capacity, amandla organizes ordinary concerns with one’s abilities to earn a wage, to strengthen one’s body, and to take care of others; it describes the potency of medicines and sexual vitality; and it captures a history of anti-colonial and anti-apartheid struggle for freedom. The ordinary actions coordinated by and directed at amandla do not obscure the wounding effects of plantation labor or the long history of racial oppression, but rather form the basis of what the Algerian artist Kader Attia calls repair. In this captivating ethnography, Cousins examines how amandla, as the primary material of the work of repair, anchors ordinary scenes of living and working in and around the plantations. As a space of exploitation that enables the global paper and packaging industry to extract labor power, the plantation depends on the availability of creative action in ordinary life to capitalize on bodily capacity. The Work of Repair is a fine-grained exploration of the relationships between laborers in the timber plantations of KwaZulu-Natal, and the historical decompositions and reinventions of the milieu of those livelihoods and lives. Offering a fresh approach to the existential, ethical and political stakes of ethnography from and of late liberal South Africa, the book attends to urgent questions of postapartheid life: the fate of employment; the role of the state in providing welfare and access to treatment; the regulation of popular curatives; the queering of kinship; and the future of custom and its territories. Through detailed descriptions, Cousins explicates the important and fragile techniques that constitute the work of repair: the effort to augment one’s capacity in a way that draws on, acknowledges, and reimagines the wounds of history, keeping open the possibility of a future through and with others.

In Cooking Data Crystal Biruk offers an ethnographic account of research into the demographics of HIV and AIDS in Malawi to rethink the production of quantitative health data. While research practices are often understood within a clean/dirty binary, Biruk shows that data are never clean; rather, they are always “cooked” during their production and inevitably entangled with the lives of those who produce them. Examining how the relationships among fieldworkers, supervisors, respondents, and foreign demographers shape data, Biruk examines the ways in which units of information—such as survey questions and numbers written onto questionnaires by fieldworkers—acquire value as statistics that go on to shape national AIDS policy. Her approach illustrates how on-the-ground dynamics and research cultures mediate the production of global health statistics in ways that impact local economies and formulations of power and expertise.

In the industrialized nations of the global North, well-funded agencies like the CDC attend to citizens' health, monitoring and treating for toxic poisons like lead. How do the under-resourced nations of the global South meet such challenges? In Edges of Exposure, Noémi Tousignant traces the work of toxicologists in Senegal as they have sought to warn of and remediate the presence of heavy metals and other poisons in their communities. Situating recent toxic scandals within histories of science and regulation in postcolonial Africa, Tousignant shows how decolonization and structural adjustment have impacted toxicity and toxicology research. Ultimately, as Tousignant reveals, scientists' capacity to conduct research—as determined by material working conditions, levels of public investment, and their creative but not always successful efforts to make visible the harm of toxic poisons—affects their ability to keep equipment, labs, projects, and careers going.