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Medicine, Mobility, and Power in Global Africa: Transnational Health and Healing

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Recent political, social, and economic changes in Africa have provoked radical shifts in the landscape of health and healthcare. Medicine, Mobility, and Power in Global Africa captures the multiple dynamics of a globalized world and its impact on medicine, health, and the delivery of healthcare in Africa--and beyond. Essays by an international group of contributors take on intractable problems such as HIV/AIDS, malaria, and insufficient access to healthcare, drugs, resources, hospitals, and technologies. The movements of people and resources described here expose the growing challenges of poverty and public health, but they also show how new opportunities have been created for transforming healthcare and promoting care and healing.

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12 Chapters

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1 The Choreography of Global Subjection: The Traditional Birth Attendant in Contemporary Configurations of World Health

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Stacey A. Langwick

This chapter is about how transnational collaborations elicit a global subject. It takes the Traditional Birth Attendant (TBA) as the site for unraveling the movements critical to an African globality. The TBA, as it was forged in the health crises of the second half of the twentieth century, is both a radically localized figure and a completely global product. Anthropologists have recognized that health development and humanitarianism are powerfully evocative spaces from which to examine the forms of violence as well as the kinds of liberation tied up in the obligations and ethics of medical interventions (Fassin 2008; Nguyen 2005; Peterson forthcoming; Redfield 2005, 2006, 2008). The marginality of the TBA within biomedical discourse—the suspicions as well as the hopes it generates, the controversies as well as the solutions it sustains—leads our attention in a different direction than ethnographies of other global medical interventions do, however (for example, in this volume see chapter 4 by John Janzen). The TBA recasts how we think about global subjectivity. As global health governance elicits the world as a set of nested administrative units—the global, the regional, the national, and the local—the subject is formulated as one more level of administration.

 

2 Targeting the Empowered Individual: Transnational Policy Making, the Global Economy of Aid, and the Limitations of Biopower in Tanzania

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Hansjörg Dilger

In October 2001, Amelia Jacob from Tanzania was among the four awardees of the prestigious Africa Prize for Leadership, an award presented on an annual to biannual basis to outstanding African leaders whose “accomplishments have improved the lives of tens of millions of people.”1 The award—among whose previous recipients were the former South African President Nelson Mandela (1994) and the founder of the Green Belt Movement in Kenya, Wangara Muta Maathai (1991)—acknowledged Jacob’s long-term engagement in the fight against HIV/AIDS in Tanzania. According to the award-giving institution, the New York–based Hunger Project, the example set by Jacob, who has lived openly with her illness since she was diagnosed as being HIV-positive in 1993, “has empowered people living with HIV/AIDS to come forth and become spokespersons. [Jacob] has demanded that the public treat people with HIV/ AIDS with dignity and compassion while advocating that any effective treatment must include warmth and respect to those living with HIV/AIDS.”2

 

3 Health Security on the Move: Biobureaucracy, Solidarity, and the Transfer of Health Insurance to Senegal

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Angelika Wolf

“Ce n’est pas facile!” Mr. Dembele shook his head. He was trying to understand the difference between budget and capital, as well as between budget and money Understanding this was necessary to evaluate the financial viability of his mutual health organization in one of the quarters of Diourbel town in Senegal. As one of the many volunteers in the administration of such an organization, he had been invited to participate in a workshop on “planning, monitoring and evaluation for administrators of mutual health organizations.”1 For two days he and the other 30 participants attempted to learn how the administration of a mutuelle de santé—a mutual health organization—should work, in particular how its staff should organize, oversee, and assess their organization. The workshop was conducted by one of the district hospital’s vice directors under the auspices of the regional office of the Health Ministry. It was, however, organized by the umbrella organization of the regional health insurance initiative Coordination Régionale des Mutuelles de Santé de Diourbel (CORMUSAD) and financed by the German Society for Technical Cooperation (Gesellschaft für technische Zusammenarbeit, GTZ), a development organization working on behalf of the German government. Such events occasionally occur in Diourbel and comprise part of development organizations’ activities to set up mutual health organizations (MHOs) in Senegal.

 

4 Afri-global Medicine: New Perspectives on Epidemics, Drugs, Wars, Migrations, and Healing Rituals

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John M. Janzen

The three case studies that make up this chapter illustrate what I call “Afri-global medicine.” By this I mean: on the one hand, situations in which sickness and healing in an African setting are affected, addressed, or handled by wider global forces or agencies; or, on the other hand, persons, practices, or materia medica that, having originated in an African setting, are used far from their origins yet in a manner reminiscent of, or in keeping with, their original characteristics. The first case study involves Ebola viral hemorrhagic fever outbreaks in Central Africa in the early 2000s, and the constellation of individuals and agencies that came together to deal with the epidemic. The second focuses on the effort to prospect and market pharmaceuticals derived from African medicinal plants. The third is about transplanted, transnational African refugee immigrants. Each case begins with a particular set of individuals who by their actions engage wider, global connections, exchanges, and movements.

 

5 AIDS Policies for Markets and Warriors: Dispossession, Capital, and Pharmaceuticals in Nigeria

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Kristin Peterson

Most of the literature on globalization that theorizes flexible capital, flows (media, migration, technology), global cities, cosmopolitanism, and local–global relationships proceeds from an analysis of finance and manufacturing capital.1 Such paradigms account for accumulation, speed, and the migratory patterns of both people and technology via capital circulating among cybernetic and physical spaces. As one imagines the enormity of capital movement, what is said of the spaces and places that are emptied out, from which these voluminous forms of capital are originally extracted? As it is widely recognized that the African continent continues to provide raw material in the form of oil, minerals, and cash crops to the rest of the world in crumbling and non-reproducible ways, can there be an analysis of an emptied-out space as the left-behind effect of such movement? Can there be an accounting of this space that is connected to but defies overlap with other spaces in the transnational realm; an account that, though cannot always imagine how raw material and capital are transformed and consumed beyond its boundaries, is not parochial in the estimation of its own loss?

 

6 Assisted Reproductive Technologies in Mali and Togo: Circulating Knowledge, Mobile Technology, Transnational Efforts

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Viola Hörbst

Aissetou (43), an academically trained Malian, was working for an NGO and was economically independent. She married Moustaffa (45) in 1999. Although both had already had children with other partners, Aissetou and Moustaffa were seeking to have children together. Thus, they began trying to conceive shortly after the wedding. Aissetou visited a gynecologist, who discovered that one of her tubes was blocked. Soon after this, she had an operation in France. Later, in 2004, two myomas were removed in Dakar, Senegal. Aissetou had known about in-vitro fertilization (IVF) for many years as a general possibility for treating female infertility. But it was only in 2005 that a conversation with a Malian friend who was then living in Canada gave her the idea that this might be an option for her. He recommended a Canadian clinic, which she contacted in 2005.

Until this conversation, Aissetou had had doubts about whether IVF could really work and wanted to try what for her seemed more obvious forms of treatment. Nowadays she considers this to have been a serious waste of time that eventually exacerbated her problems. She wanted to go to Canada, but was unable to get a visa from the Canadian embassy in Bamako. She therefore changed her plans and went to Germany instead, where she had relatives. Her husband joined her there for a week, during which an intracytoplasmic sperm injection (ICSI) was carried out. Unfortunately, the procedure failed to result in pregnancy

 

7 Flows of Medicine, Healers, Health Professionals, and Patients between Home and Host Countries

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Flows of Medicine, Healers, Health Professionals, and Patients between Home and Host Countries

Abdoulaye Kane

This chapter examines the flows of medicine and health care services both biomedical and traditional between the villages of the Senegal River Valley and the Haalpulaar1 immigrant communities in France. Haalpulaar migrants in France are intervening in their home communities to help ensure that people at home have access to health care. Both individual and collective forms of agency grow in the process of medicine transfers between the two places. On the one hand, individuals abroad send biomedical medicine to their rural homes, and family members send traditional medicine to France. On the other hand, Haalpulaar migrants’ associations like Thilogne Association Développement (TAD) and Fouta Santé are improving access to health care in the Senegal River Valley through remittances of biomedicine and medical equipment as well as the organization of annual health caravans with the participation of French health professionals and local partners.

 

8 Public Health or Public Threat? Polio Eradication Campaigns, Islamic Revival, and the Materialization of State Power in Niger

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Adeline Masquelier

In late 2003 rumors began circulating in the small provincial town of Dogondoutchi, Niger that the poliomyelitis vaccine administered to children was harmful. The vaccine, the rumor had it, caused sterility in children and had been developed by Western scientists to lower the world’s Muslim population. When nurses dispatched to administer doses of Oral Polio Vaccine (OPV) to children under five tried to enter people’s homes on National Vaccination Day, they were met with staunch resistance on the part of some parents who accused them of wanting to harm their progeny. In surrounding villages, similar scenarios ensued as health workers going house to house with polio drops tried to immunize the children targeted by the vaccination drive. Eager to cut short the emergence of a massive opposition to the WHO-sponsored campaign to eradicate polio, the secrétaire général of the Dogondoutchi prefecture dispatched police officers to a village where residents had denied health workers access to their children. There the officers promptly arrested two individuals who, by protesting the presence of health workers, had interfered with the drive. The two men were brought to Dogondoutchi under police escort. Once in the secrétaire général’s office, they were lectured about the benefits of vaccination before eventually being released, but not before being charged a fine amounting to the cost of sending a health worker back to the village to resume inoculation. Despite concerted attempts by local public health officials to prevent further disruptions of the vaccination drive and alleviate parental concerns regarding the safety of the OPV, rumors that the vaccine was part of a Western plot to sterilize Muslim girls (and in some minds, boys as well) continued to hinder the success of the 2003 campaign. The vaccine was not safe, embattled residents reasoned, otherwise why weren’t parents charged for it? After all, the government did not provide other free services anymore. In the eyes of suspicious parents the only reasonable explanation was that local officials were acting on behalf of impious Westerners eager to weaken the country’s Muslim resurgence. While parental fears were largely articulated around the notion that the OPV caused infertility, a few individuals suspected the vaccine of inducing atheism. For yet others, it was the vaccine itself that struck children with polio. In some communities, polio campaigns were thwarted by alarmist claims that the vaccine passed on the AIDS virus and had been devised to deplete the world of its Muslim population.1

 

9 School of Deliverance: Healing, Exorcism, and Male Spirit Possession in the Ghanaian Presbyterian Diaspora

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Adam Mohr

The political and social changes associated with globalization in the last two decades have resulted in radical shifts in the circulation of people, religious institutions, and healing practitioners between Africa and the African-born immigrants in the U.S. In particular, the large-scale immigration of Ghanaian Christians to the U.S. has led to the formation of a network of Ghanaian Presbyterian churches in North America. This network of churches has attempted to reproduce healing practices established at the Grace Deliverance Center in Ghana—the primary religious healing center of the Presbyterian Church of Ghana—through an annual healing and deliverance workshop held in New York. This school of deliverance is the principal mechanism by which the practices of deliverance—meant to free a person from illness or misfortune emanating from Satan—are taught to members of the Presbyterian Church’s Prayer Teams, which are sub-church organizations responsible for the health and welfare of their congregations.

 

10 It’s Just Like the Internet: Transnational Healing Practices between Somaliland and the Somali Diaspora

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Marja Tiilikainen

At the airport of Addis Ababa, Ethiopia, in the summer of 2005, I became acquainted with Faadumo. Both of us had traveled the same route all the way from Finland, and we both were on the way to Hargeysa in northern Somalia—Faadumo was going to visit her family and I was going to do my first fieldwork in the area. Faadumo was a young woman with a neat appearance. Her head was uncovered, and she was wearing a long jean skirt. As we approached Hargeysa, she covered herself with a black veil. Faadumo seemed to take interest in my study and told me that her mother knew a lot about traditional healing practices. At that time I did not yet foresee that Faadumo would become one of my key informants. Her multifaceted and even tragic story gradually came to light over several meetings in Somalia and Finland. Faadumo was divorced and had a teenage son who had been raised by Faadumo’s mother in Hargeysa. She was in regular contact with the child by telephone, the internet, and annual visits. In recent years she had tried to bring the child to Finland, but the Finnish authorities did not believe that she was the biological mother. In Finland Faadumo had suffered from various symptoms and illnesses, such as stomach pain and loss of appetite. She had also become increasingly mistrustful of other people and had started to isolate herself at home. According to a Finnish doctor, Faadumo was depressed, but according to an Islamic scholar and healer (sheikh) in Hargeysa, these symptoms were caused by witchcraft. One of the aims of Faadumo’s trip was to verify this diagnosis and, if necessary, try the sheikh’s treatment, which she had earlier refused.

 

11 Mobility and Connectedness: Chinese Medical Doctors in Kenya

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Elisabeth Hsu

Since the late 1980s, Kenya has seen a constant coming and going of Chinese medical doctors. These traveling medical experts have not been excessively numerous (during the last 20 years their numbers have ranged between only 20 and 40 persons at any point in time), and they are not exactly a public health issue, but the complexities of their situation are worthy of anthropological investigation. During my fieldwork, one of the most pressing questions that local patients, health personnel, acquaintances on the bus, or colleagues at the university asked was: who are these Chinese medical doctors and why have they come to us?

In order to answer this question asked by one set of actors during my fieldwork, I elicited the individual life stories of another set of actors, the Chinese doctors themselves. The question was simple; it came from the grassroots. The stories were moving, and they stand for themselves. However, their analysis points out important blanks in the medical anthropological literature.

 

12 Guinean Migrant Traditional Healers in the Global Market

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Clara Carvalho

West African traditional therapists, healers, and ritual experts have crossed national and continental borders, spreading their therapeutic knowledge and worldview along their migrant itineraries. Nowadays, in every southern European capital, West African therapists act professionally in different contexts and for a varied clientele, including African and non-African, immigrant and local patients. Being migrant workers themselves, they become cultural brokers, mediating circuits of information and power amongst their patients. Although this process is not a new one, it changed in scope and vitality in the 1990s, a decade marked by the imposition of structural adjustment plans (SAPs) on indebted southern economies, a measure that led to the liberalization of the markets but also increased the impoverishment of both the working class and the emerging middle class in Africa, contributing to the flow of migrants from the global South to the global North. Amongst these migrants seeking better lives were therapists, religious experts, and other professional healers practicing local traditions. The mobility of such traditional workers has long been noticed in different African settings at a regional level, as has their capacity to adapt their knowledge to different challenges and situations (Feierman 2006; West and Luedke 2006). In 1992, Feierman and Janzen drew attention to the changing patterns of health and healing in Africa. Nowadays patients have a varied set of options for diagnosis and treatment, and it is the reasons behind their choices that anthropologists try to understand when studying the concepts of health and disease from the patients’ point of view. Patients can choose amongst local healing traditions, both religious and biomedical, which have their own distribution in time and space. These different systems have their own dynamic, and (as medical anthropologists have stressed) so-called “healing traditions” have changed according to the new conditions of health and disease of their patients (Feierman and Janzen 1992; Nichter and Lock 2002). Different living conditions resulting from changes in political control and economic production, as well as new or newly widespread diseases (especially tuberculosis, malaria, and now HIV/AIDS), have led healing practices to change accordingly. This is particularly true for migrant populations, both within Africa and beyond. The intensification of the flow of migrants from Africa to Europe has made the movement of both people and ideas, including healing practices, along the migration routes more obvious, and created a new challenge for traditional healers.

 

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