Understanding Tuberculosis and its Control: Anthropological and Ethnographic Approaches

Description

Over the last two decades attempts to control the problem of tuberculosis have become increasingly more complex, as countries adopt and adapt to evolving global TB strategies. Significant funding has also increased apace; diagnostic possibilities have evolved; and greater attention is being paid to developing broader health systems. Against this background, this book examines tuberculosis control through an anthropological lens. Drawing on ethnographic case studies from China, India, Nepal, South Africa, Romania, Brazil, Ghana and France, the volume considers: the relationship between global and national policies and their unintended effects; the emergence and impact of introducing new diagnostics; the reliance on and use of statistical numbers for representing tuberculosis and the politics of this; the impact of the disease on health workers as well as patients; the rise of drug resistant forms and issues of attempted control. Together the examples showcase the value of an anthropological understanding to demonstrate the broader bio-political and social dimensions of tuberculosis and attempts to deal with it. Cover Half Title Title Page Copyright Page Table of contents Figures Tables Contributors 1 Introduction: Persistent pathogen Biomedical history becomes global history Anthropological approaches to studying TB Broadening the definition of the social Biomedical citizenship and the socially incurable Other socialities Global/local interfaces Concluding thoughts Notes Works cited 2 ‘I wish one of these patients would sue us’: Malpractice at the policy level and how Romania is not treating ... Methodology TB as a social disease: social causes and social barriers to treatment What is to blame for poor M/XDR-TB treatment outcomes in Romania? Diagnostics Treatment Social, economic and psychological support TB and the legal environment in Romania ‘Buy them bus tickets!’ Even free is expensive: compassionate use donations Bootlegging M/XDR-TB treatment Conclusion: if we are failing the ‘easy’ patients, what becomes of those with social and economic vulnerabilities? Afterword Acknowledgements Notes Works cited 3 ‘Where is the state?’: Tuberculosis strategies in Ghana Tuberculosis in Ghana: an historical perspective Nzema area: health system and tuberculosis in the Jomoro District ‘.“Culture” as obstacle to biomedicine’ From local interpretations to the denial of disease Conclusions: the obscuring force of ‘culture’ Notes Works cited 4 ‘Time standing still’: Nurses, temporality and metaphor in a paediatric tuberculosis ward in Cape Town, South Africa Introduction Setting the scene ‘Hospital time’ Patient life Nurses: ‘You must take the time’ Gift: time standing still/‘stuck’ in time Carlito: running out of time The enduring significance of metaphor Concluding thoughts: time standing still Notes Works cited 5 ‘It’s also the system’: Republican dilemmas in French tuberculosis prevention Introduction Method and locality Street-level bureaucracy Investigating contacts ‘We are nurses; we are not from the police’: subtle distinctions ‘For me, it’s also the system’: republican dilemmas ‘I completely let go’: professional ethics in practice Conclusion Notes Works cited 6 Using local statistics to tinker with TB treatment in a central Indian clinic Introduction ‘Therapeutic anarchy’: TB treatment options in India Jan Swasthya Sahyog: community-based medicine Everyone loves numbers Jan Swasthya Sahyog loves numbers, too Concluding comments Notes Works cited 7 Community DOTS and beyond: Tackling the collective processes that (re)produce tuberculosis in Rio de Janeiro Introduction Recent history of DOTS in Brazil The beginning of DOTS implementation in Rio de Janeiro A community approach to DOTS and tuberculosis care in Rio de Janeiro The initiatives of the municipality The initiatives of the Global Fund project for tuberculosis Limits of the community approach to DOTS in Rio de Janeiro The story of Caio Precarious life conditions Absent or insufficient health services in areas with high tuberculosis incidence Daily violence Towards a collective level approach to tuberculosis Tackling the collective processes that (re)produce tuberculosis in Rio de Janeiro Final remarks Acknowledgements Notes Works cited 8 The price of free: Contextualizing the unintended expenditures of diagnosing tuberculosis in Kunming, China Introduction Field methodology Public health aspirations: the Chinese national tuberculosis plan and the ‘double free’ policy “Tuberculosis is a money problem”: patient experience diagnosing tuberculosis Conclusion: patient experience in national context Notes Works cited 9 Innovating tuberculosis diagnostics for the point of care Addressing complex diagnostic and treatment ecosystems Practices of evaluation and evidence making on tuberculosis diagnostics How to strengthen innovation processes? Conclusion Works cited 10 India’s national TB programme: The struggle for innovation and control The project Example one: Is TB transmitted from one person to another and, if so, how? Example two: How long after taking TB medication is a patient no longer highly contagious to household members? Examples three and four: TB and mother–child health Example five: TB medication after alcohol consumption Reception by the national TB programme Conclusion Acknowledgements Notes Works cited 11 Excluded from reciprocity: Tuberculosis, conspicuous consumption and the medicalization of poverty Excluded from reciprocity Conspicuously consumptive The only winner Acknowledgements Works cited 12 Consumed in care: Healthcare workers in Mumbai’s TB-control Program Contextualizing TB in Mumbai Tuberculosis among healthcare workers in Sewri TB Hospital Invisibility and disposability: the case of community health workers/volunteers NGOs treatment of community health volunteers Personal consequences Conclusions Acknowledgements Notes Works cited 13 Between representing and intervening: Diagnosing childhood tuberculosis during a vaccine trial in South Africa Between representing and intervening SATVI’s trials in the Breede Valley Protocol and beyond: complexities on the ground The home visits The case-verification ward Conclusions Notes Works cited 14 Diagnosing tuberculosis: A case study from Nepal Introduction Scenario one: The International Organisation of Migration laboratory Scenario two: The government laboratory system Why the increased focus on case finding? What was the impact of the introduction of GeneXpert into the NTP? Integration of NGO and government services, and the question of incentives Conclusion Notes Works cited Index