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.
Author(s): Helen Macdonald; Ian Harper
Publisher: Routledge
Year: 2020
Language: English
Pages: xii+282
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
