“Global Health is like a containership. The multiple actors —international and local NGOs, humanitarian organisations, scientists, activists, politicians — operate the tugboats, attempting to nudge, tug and pull the ship into its dock, where it will be offloaded and transported, i.e. implemented, by those who were able to demonstrate the greatest technical skill and advantage. […]As anthropologists, we must continue to engage in the Sisyphean task of trying to steer the Global Health container ship, but we should also not forget that we are on the ship, nor that it is often easier to shape both the trade routes and shipping manifesto before the ship gets under way.” –Eileen Moyer
This metaphor, brought forward by Eileen Moyer in a panel on containment organized by Alex Nading and Rebecca Marsland, is just one of the many creative proposals about the relationship between global health and medical anthropology that circulated at MAGic2015. The conference, jointly organized by the EASA Medical Anthropology Network and the RAI Medical Anthropology Committee, was held at Sussex University September 9-11. The MAGic conference aimed to interrogate the paradigms and practices of Global Health.
From Wednesday to Friday, opening keynote lectures were followed by six parallel panel sessions for a total of 52 panels and lunchtime events, including the Sussex Glocal Health Hive, the annual meeting of the EASA Medical Anthropology Network and a Wellcome trust presentation on funding opportunities. The conference drew 350 participants, of whom almost a third were young scholars working in Global Health. The third meeting of its kind — in 2011 the EASA medical anthropology network held a conference on the theme of medical pluralism in Rome and in 2013 EASA and SMA joined to discuss “Engagements and Encounters” in Tarragona — the conference again offered a rich platform for formal and informal debate, the start of new collaborations and initiatives, and the space for interdisciplinary engagements.
The sheer volume of panels, covering several consecutive timeslots, led to some excellent, intimate discussions, but the overlap also created difficult choices. I spent much of the conference wishing I could be in two places at once. Panel topics covered the wide array of anthropology’s involvement in Global Health, encompassing the ‘hot’ topics of 2014-2015: Ebola and migrants’ right to health, health inequalities, the role of ethnography in HIV randomized control trials and genetic medicine. Another conference theme included the politics of Global Health concerns like obesity, mental health, maternal health and reproduction, global aging, chronicity and disability. Global Health ‘culture’ was itself unpacked: panels focused on its networks, workers, qualitative methods, health indicators, politics and stakeholders, language and discourse, unintended consequences and study of objects, commodities and technologies. More creative and reflective panels used Global Health ‘memory,’ ‘post-Humanism,’ and ‘containment and materiality’ to move us beyond conventional anthropological thinking in and about Global Health.
So, what was the buzz? First of all, in a land of plenty and limited time there is always Twitter! MAGic’s hashtag (#MAGic2015conference) was used abundantly. Some tweets included:
Just out of fascinating session on post-humanism, health and anthropology. Thanks co-panelists! #MAGic2015conference @SussexGlobal @IDS_UK
— Elizabeth Mills (@EMills_IDS) September 10, 2015
Dr. Brigit Obrist – #Anthropology should continue to critically reflect on the 'lures of global health' #magic2015conference
— j m de lopez (@jennachiapas) September 10, 2015
What happens when #anthropology gets translated into "qualitative research"? What's the difference? Panel 40 @ #MAGic2015conference
— Anna Ruddock (@annalouruddock) September 9, 2015
Lesson2 #Magic2015conference. See health as between people not (just)within bodies.
— Bregje de Kok (@BregjedeKok) September 14, 2015
The Ebola response needs to go beyond the idea of the community to the community as lived locally #MAGic2015conference
— IDS Nutrition (@IDS_KSNutrition) September 9, 2015
Really enjoyed @eyatesd on social determinants of health at #MAGic2015conference. Need to talk more about cause and value. @MedAnthUoE
— Alex Nading (@AlexNading) September 9, 2015
Lesson 1 #Magic2015conference. Anthro shows: Focus on risky health systems, not risky women for #mnch.
— Bregje de Kok (@BregjedeKok) September 14, 2015
Fascinating talk on beekeeping and bee health. Why do we think about bees differently to other insects?@BeckieMarsland #MAGic2015conference
— Rebecca Lynch (@r_j_lynch) September 11, 2015
Chiara Dallavalle speaks at #MAGic2015conference. Mental health needs of asylum seekers @IrishMedAnthro pic.twitter.com/kD9E0Tq4nX
— IrishMedAnthroNet (@IrishMedAnthro) September 10, 2015
Critique of RCTs Vinanne Adams asking: Are we operating under a new kind of sovereignty? #magic2015conference
— j m de lopez (@jennachiapas) September 11, 2015
My highlights included the panel on containers and the material life of Global Health, which focused on objects that interfere with the spread of disease or with diagnosis. To give you some examples: Alex Nading talked about improvised containers for the collection of shit in Nicaragua as part of a “crafted bureaucracy”, Mirko Pasquini discussed the glass barrier in Italy’s emergency rooms, and Eileen Moyer talked about the containers as black boxes transporting interventions, in this case “male involvement initiatives”, in HIV eradication.
Another personal highlight was the panel “Anthropology on trial? The role of ethnography in HIV experimental science”. Eva Vernooij described her alternating roles as coordinator and observer of a large Treatment as Prevention programme in Swaziland, Shelley Lees followed with a presentation on the challenges and possibilities for anthropological involvement in HIV and Ebola Virus Disease prevention risks, and Denielle Elliott presented a creative paper in which she publicly conversed with an epidemiologist who was the director of a HIV research project in a large state-run clinical research center in Kenya. It was fascinating to see the different roles medical anthropologists can assume when collaborating with global health workers. Whereas Eva Vernooij sought pathways to study the trial as a social and political intervention, she also changed the trial’s course through her engagement. Shelley Lees defined her position as an ally of the community, guarding ethics and thinking about how to improve the set-up of clinical trials. Denielle Elliott, on the other hand, took an overtly politically-engaged stance, critically analysing clinical trials as fundamentally exploitative but also highlighting the immense difficulties in communication between anthropologists and (willing) epidemiologists coming from divergent epistemological backgrounds.
The divergent engagements of anthropology with Global Health were also central in the plenaries and keynote lectures. In the first plenary, “Anthropology in the time of Ebola: anthropological insights in a Global Health emergence”, Sylvain Faye discussed the way “community participation” was framed by health authorities as resistance to government, rather than as a critique of government denial and its lack of recognition of local perspectives. Melissa Leach subsequently used anthropology’s engagement in the Ebola response as a way to discuss and overcome “tired distinctions” and reach new models for future responses to Global Health threats. The theme of anthropological engagements with/in/about Global Health was taken up in the keynote by Brigit Obrist on the “lures” and “perils” of engaged medical anthropology, where she urged anthropologists to continue to provide grounded community work questioning ‘best practice’ models. A wonderful keynote by Vincanne Adams focused on public-private-for-profit partnerships within the broader context of Global Health’s growing reliance on evidence-based metrics and its concerns for cost-effectiveness. She juxtaposed the global health community’s use of anecdote to legitimize their measures against the deep engagement of ethnographic storytelling.
The general buzz about anthropology’s engagement with Global Health seemed far away in my own panel, “Global Ageing: Towards a Shift From Cure to Care”, organised by Piet van Eeuwijk. The panel opened with a presentation by Jason Danely on caretakers for older people in Japan. He sketched the world of eldercare in Japan through vivid phrases: the “kidnappers” coming to round up older people early in the morning; the intimacy of care work, which in Japan is framed in similar categories as “hostess” work; and the constant manoeuvring of caretakers between the boundaries set by policy and feelings of responsibility for older clients. In doing so, the paper made an excellent case for closely examining caretaker vulnerability. Through rich case studies, Renske Visser, the next presenter, analysed implicit policy assumptions of what a “good death” entails in the United Kingdom and how elderly people’s wishes are not a stable entity but change in conversation with their physical ability. This formed a nice link to the paper I presented on how relations between grandparents and grandchildren in Tanzania change over time in the AIDS era. In my work “strength” and physical ability are central in the care work of raising grandchildren, but this plays out differently when children are infants, adolescents, or young adults. Also focusing on Tanzania, Piet van Eeuwijk continued the theme of strength when discussing the rise of diabetes among middle-class elderly people in Dar es Salaam and their difficulties in managing much-needed chronic care.
Thinking about the limited interest in aging at the conference — with only eight people present (including panel participants) our session was rather intimate — I could not help but wonder whether current trends in Global Health, including the focus on technology and measurable evidence that we anthropologists so like to critique, are not also a lure for medical anthropologists themselves. Aging, care, disability: totally unsexy. Technologies: sexy! Surely it is not just funding mechanisms or urgency that shape medical anthropology’s engagement with Global Health. Perhaps our own disciplinary interests are more influenced by what is in fashion than we would like to imagine. By the close of the conference I found myself asking: Isn’t it time to not just tug at and nudge around the edges of the Global Health field, but to embrace, unpack, and, particularly, transport the richness and broad scope with which we view our subjects and apply those lenses to our own practices in Global Health, as well?
Josien de Klerk is a lecturer in the Global Public Health major at Leiden University College, The Hague. She has worked extensively on aging in the era of AIDS in Kenya and Tanzania, studying informal care, including self-care of both affected and infected older people in rural and urban settings. Her fieldwork is the basis of critical analysis of the politics around aging and care in the treatment-dominated AIDS landscape in East-Africa. Her current research interests center around the consequences of social welfare policies, looking at the introduction of social pensions in East-Africa and the (im)mobility of Dutch pensioners in Spain in the context of increasing austerity measures.