Perspectives on Global Health
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Global Health in Africa is a first exploration of selected histories of global health initiatives in Africa. The collection addresses some of the most important interventions in disease control, including mass vaccination, large-scale treatment and/or prophylaxis campaigns, harm reduction efforts, and nutritional and virological research. The chapters in this collection are organized in three sections that evaluate linkages between past, present, and emergent. Part I, “Looking Back,” contains four chapters that analyze colonial-era interventions and reflect upon their implications for contemporary interventions. Part II, “The Past in the Present,” contains essays exploring the historical dimensions and unexamined assumptions of contemporary disease control programs. Part III, “The Past in the Future,” examines two fields of public health intervention in which efforts to reduce disease transmission and future harm are premised on an understanding of the past. This much-needed volume brings together international experts from the disciplines of demography, anthropology, and historical epidemiology. Covering health initiatives from smallpox vaccinations to malaria control to HIV campaigns, Global Health in Africa offers a first comprehensive look at some of global health’s most important challenges.
The Riddle of Malnutrition
More than ten million children suffer from severe acute malnutrition globally each year. In Uganda, longstanding efforts to understand, treat, and then prevent the condition initially served to medicalize it, in the eyes of both biomedical personnel and Ugandans who brought their children to the hospital for treatment and care. Medicalization meant malnutrition came to be seen as a disease—as a medical emergency—not a preventable condition, further compromising nutritional health in Uganda. Rather than rely on a foreign-led model, physicians in Uganda responded to this failure by developing a novel public health program known as Mwanamugimu. The new approach prioritized local expertise and empowering Ugandan women, blending biomedical knowledge with African sensibilities and cultural competencies. In The Riddle of Malnutrition, Jennifer Tappan examines how over the course of half a century Mwanamugimu tackled the most fatal form of childhood malnutrition—kwashiorkor—and promoted nutritional health in the midst of postcolonial violence, political upheaval, and neoliberal resource constraints. She draws on a diverse array of sources to illuminate the interplay between colonialism, the production of scientific knowledge, and the delivery of health services in contemporary Africa.
The Experiment Must Continue
The Experiment Must Continue is a beautifully articulated ethnographic history of medical experimentation in East Africa from 1940 through 2014. In it, Melissa Graboyes combines her training in public health and in history to treat her subject with the dual sensitivities of a medical ethicist and a fine historian. She breathes life into the fascinating histories of research on human subjects, elucidating the hopes of the interventionists and the experiences of the putative beneficiaries. Historical case studies highlight failed attempts to eliminate tropical diseases, while modern examples delve into ongoing malaria and HIV/AIDS research. Collectively, these show how East Africans have perceived research differently than researchers do and that the active participation of subjects led to the creation of a hybrid ethical form. By writing an ethnography of the past and a history of the present, Graboyes casts medical experimentation in a new light, and makes the resounding case that we must readjust our dominant ideas of consent, participation, and exploitation. With global implications, this lively book is as relevant for scholars as it is for anyone invested in the place of medicine in society.
Preaching Prevention
Preaching Prevention examines the controversial U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) initiative to “abstain and be faithful” as a primary prevention strategy in Africa. This ethnography of the born-again Christians who led the new anti-AIDS push in Uganda provides insight into both what it means for foreign governments to “export” approaches to care and treatment and the ways communities respond to and repurpose such projects. By examining born-again Christians’ support of Uganda’s controversial 2009 Anti-Homosexuality Bill, the book’s final chapter explores the enduring tensions surrounding the message of personal accountability heralded by U.S. policy makers. Preaching Prevention is the first to examine the cultural reception of PEPFAR in Africa. Lydia Boyd asks, What are the consequences when individual responsibility and autonomy are valorized in public health initiatives and those values are at odds with the existing cultural context? Her book investigates the cultures of the U.S. and Ugandan evangelical communities and how the flow of U.S.-directed monies influenced Ugandan discourses about sexuality and personal agency. It is a pioneering examination of a global health policy whose legacies are still unfolding.
The History of Blood Transfusion in Sub-Saharan Africa
This first extensive study of the practice of blood transfusion in Africa traces the history of one of the most important therapies in modern medicine from the period of colonial rule to independence and the AIDS epidemic. The introduction of transfusion held great promise for improving health, but like most new medical practices, transfusion needed to be adapted to the needs of sub-Saharan Africa, for which there was no analogous treatment in traditional African medicine. This otherwise beneficent medical procedure also created a “royal road” for microorganisms, and thus played a central part in the emergence of human immune viruses in epidemic form. As with more developed health care systems, blood transfusion practices in sub-Saharan Africa were incapable of detecting the emergence of HIV. As a result, given the wide use of transfusion, it became an important pathway for the initial spread of AIDS. Yet African health officials were not without means to understand and respond to the new danger, thanks to forty years of experience and a framework of appreciating long-standing health risks. The response to this risk, detailed in this book, yields important insight into the history of epidemics and HIV/AIDS. Drawing on research from colonial-era governments, European Red Cross societies, independent African governments, and directly from health officers themselves, this book is the only historical study of the practice of blood transfusion in Africa.