LSE’s Claire Coultas says that this volume provides rich testimonies to the enormous diversity in African experiences with public health, although the narrative that pulls these essays together could have been more nuanced.
The essays in this book, Making and Unmaking Public Health in Africa: Ethnographic and Historical Perspectives provide a rich and nuanced insight into people’s experiences as they interact with public health through connecting ethnographic fieldwork with historical perspectives. They illustrate clearly the ways in which the political plays out at the personal and the diversity in framings of health and healthcare as different knowledges meet, situated in particular socio-historical contexts. As the post-2015 agenda moves forward based on standardised indicators and transnational processes, closer inspection of the heterogeneity in localised public health through the lived experiences of those interacting with and working within it becomes ever more important. The editors identify two core objectives in collating the various essays. Firstly, it is to connect the history of biomedical modernisation and public health to the experiences of ‘African publics’ in providing or receiving medical care. Secondly, they work to situate and consolidate past and present framings of public health that engage or disengage with African publics, emphasising the active role that ordinary people play in transforming interventions according to their own needs.
The essays are grouped into three sections. The first, titled ‘Whose Public Health?’ demonstrates the variance by which this term is understood, determined to a large extent by wider historical and political processes specific to different contexts. Murray Last draws on 50 years of working in northern Nigeria to discuss the ways in which decentralisation processes coupled with long-standing tensions between state and person as well as Christian, Muslim and more esoteric values, have politicised access to and interactions with biomedical public health services. Rebecca Marsland unpacks the singular efforts of district-level government officials in southern Tanzania to tackle out-of-control community witchcraft beliefs using the language of public health, also problematising the ways in which this framing paints a picture of these rural publics as ‘crowds of irrational masses of unhygienic bodies’ (p.84). Noémi Tousignant describes an altogether different scenario in Senegal where pharmacists situated in the private sector have in the period since independence held varying positions in state health responses, conceptualised as ‘responsible citizens’ that protect and speak for a ‘passive target population’.
The second section of the book explores ‘Regimes and Relations of Care’ providing poignant accounts of the person within public health initiatives. The story of Anna, an HIV-positive home-based care client in Uganda demonstrates the discord between project and life trajectories (Lotte Meinart), while Hannah Brown’s essay situates community women’s groups working on home-based care programmes in Kenya as building on state legacies of mobilising the domestic sphere in ways that serve all parties. Alternatively Benson Mulemi describes how hospital staff working on a poorly-resourced cancer treatment ward in Kenya draws on strategies outside of biomedicine to protect hope for patients against dire odds. The final section – ‘Emerging Landscapes of Public Health’ – then works to unpack new topographies of health and healthcare in African contexts looking at diabetes in Uganda (Susan Reynolds Whyte), the opportunities and gaps created by temporally unstable ‘millennium cities’ (Ruth J. Prince), and the ways in which high-tech medical research field stations impact on the communities around them and the people that traverse between (P Wenzel Geissler).
Yet despite all of these essays together providing rich testimonies to the enormous diversity in African experiences with public health, I felt that this was in places undermined by the narrative which pulled them together. The introduction takes on the ambitious task of ‘Situating Health and the Public in Africa’ providing an account spanning from colonial times to the modern day. Yet much of this discussion is illustrated in the essays and in my view could have been drawn together in a much more specified way in a conclusion, as opposed to the sweeping and essentialist statements that are difficult to avoid when trying to cover over a hundred years of enormously different socio-political landscapes. Furthermore the book ends with a chapter that is completely decontextualized describing movements of de-personified people connected to ‘a transnational medical research station that operates in and around a medium-sized African city’ (p.235). The purpose of this mystification is unclear as the author’s website names this site as Kisumu, Kenya, the same city where the previous chapter is situated. Certainly Kenya does feature prominently throughout the book, and with only four other countries being depicted in the other essays, the book’s generalised claims to ‘Africa’ is again somewhat compromised.
This is a shame because I don’t think that an ‘African narrative’ is what is needed to bind these essays together. Contemporary notions in African studies involve efforts to move away from old ‘Africanist’ rhetoric that homogenises and is determined by outsiders, to voices that speak of the enormous diversity not only between but also within African countries. This is where I would suggest the power of these essays lies. An overarching narrative based on the methodological contribution that this connecting of ethnographic fieldwork with historical perspectives makes in terms of opening up for analysis the nuanced variations of experience in African contexts would have been much stronger. For together, these essays really do give a beautiful and personalised insight into the making and unmaking of public health in African contexts.
Making and Unmaking Public Health in Africa: Ethnographic and Historical Perspectives, Editors Prince, R. J. and Marsland, R. (2014)
Ohio University Press, USA.
Clare Coultas is a research student at LSE.
The views expressed in this post are those of the author and in no way reflect those of the Africa at LSE blog or the London School of Economics and Political Science.