Mass Drug Administration as Experiment: Distributing Ivermectin in a Rural Town in Southern Ghana

The development of the Ivermectin won their creators the 2015 Nobel Prize in Physiology or Medicine. However, in spite of the development of the pharmaceutical made a great contribution to global health, it does not lead straightforwardly to the eradication of the infectious disease. Ivermectin has been distributed through the mass drug administration program in Ghana. This program prescribes the drug for the entire population, regardless of individuals’ infection status. At the community level, volunteers conduct actual tasks such as walking around communities, explaining the drug and onchocerciasis to people and administering Ivermectin. Recordkeeping is another important task. They have a book with printed forms to write down particular information of each household and its members such as address, names, ages, heights, and clinical conditions. The clinical conditions column may be filled with elephantiasis, hydrocele, blindness, dermatosis, and side reactions. These conditions show the symptoms of onchocerciasis. Therefore, the mass Ivermectin administration program is not only a curative and preventive technology but also a diagnostic and experimental technology. Describing how health workers engage in the mass Ivermectin administration program in Southern Ghana, this paper explores experimental aspects of dispensing pharmaceuticals.

“Do not use herbs!”: Plants and Pills in Maternal Health Care in Ghana

By the end of the 20th century, women living in African countries had a 1 in 15 lifetime risk of dying during pregnancy. Many resided in rural areas where state of the art maternity wards in hospitals were not available, or in urban settings where hospitals were overpriced and overextended. So, many women turned to neighbors, family, and healers to help them through pregnancy and labor. This talk considers efforts in the West African country of Ghana to improve maternal care through a network of trained “Traditional Birth Attendants,” or TBAs. Interviews with policy makers and healers reflecting on their involvement in TBA programs from the 1970s as well as archival documents, training manuals, and observations from field research in the Akuapem Mountains, show how Ghanaians hoped to implement a program widely touted through the World Health Organization as critical to stopping maternal mortality. In particular, the talk will analyze the use of both pharmaceuticals like Syntocinon (synthetic oxycotin) and plants like Nfofo leaves (Aspilia africana) in peri-natal care. Overtime, Ghanaian policymakers encouraged TBAs and healers to avoid using herbs to stop hemorrhaging and other complications. By the early 2000s, government went so far as to ban TBAs, and urged all women to deliver with a skilled attendant such as a nurse midwife or obstetrician. This talk is part of Professor Osseo-Asare’s larger interest in affording equivalent access to medical knowledge to communities around the world and the ongoing quest for new chemicals from healing plants. It takes cues from research of a number of scholars on the history of traditional medicine in Ghana and other African settings, including Karen Flint, Matthew Heaton, Kwasi Konadu, Stacey Langwick, Jonathan Roberts, and Patrick Twumasi. The talk will unpack the many layers to indigenous healing, a topic often romanticized despite health outcomes.

Image: Women wait at the Padan Ante-natal Clinic in Kasoa, Ghana, 2003
(photo by Osseo-Asare)

Experimenting with “Folk Medicines”: Medicinal Plants as Intellectual Property in India

Bioprospecting is a new name for an old practice; it refers to the scientific investigation of plants and folk medicines in the hope of discovering clues for developing new drugs. Its revival in the 1980s raised issues about intellectual property of indigenous people, requiring bioprospecting scientists to make legitimate benefit-sharing agreements with the resource owners and communities. Despite the “ethical” look of such movement, anthropologists of science, technology, and medicine have criticized it as the new form of “biocapitalization” by penetration of neoliberal logic into “nature” and folk medicine (cf. Rajan 2006). Especially in the case of India, where the government has initiated to create databases of “valuable” traditional medicine like Ayurveda (as “Indian intellectual property”), such criticism was directed to the way in which the complex composition of Ayurveda was disentangled and reorganized into elementary botanical units to be commensurate with the global pharmaceutical trend/patent system (Gaudillière 2014). While recognizing the significance of such critiques of biocapitalism from the wider political-economy perspective, this paper takes a rather different approach to explore the politics embedded in the semio-material process of databasing Ayurveda and herbal plants. Ethnographically exploring the state government’ project in Uttarakhand, the Northern rural state called as “Herbal State (jadi buti pradesh),” it sheds light on how the project relies on postcolonial herbal relations, but at the same time generates new relations and tensions among particular medicinal plants (jadi buti), folk Ayurvedic healers (vaidyas), and local plant taxonomists. The focus on the materiality/vitality of jadi buti will bring the moment of unexpected change of power relations between scientific and vaidyas’ taxonomies into light, showing the necessity of grasping such project as “social experiment” rather than reflection of universal process of biocapitalization.

From drugs for life to living for drugs: viewing hospice from institutional/pharmaceutical perspectives

This paper aims to provide observations about the end of life’s journey from a perspective that echoes the recent STS scholarship concerning drugs and the human condition drugs create. Departing from existing literature that treats aging care and hospice/end-of-life care separately, this paper insists that observing the life paths of an aging individual is a necessity. It also argues for a preliminary yet serious investigation of aging people’s social and bodily conditions as well as their dynamic relationship with pharmaceuticals. Among the numerous sites that emerge in an aging society, this study focuses on hospice wards, out-patient clinics, and health promotion centers. They were chosen in order to exemplify the social and cultural characteristics of how aging people cope with the inevitable routine of taking drugs. This paper hopes to reveal not only the ways aging people are provoked into taking drugs in order to maintain their way of life, but also the transfiguration of these people as they start losing control over their bodies and social lives and become subject to institutional care/death. Therefore, this paper is a scholarly snapshot of our lives on pharmaceuticals or, more exactly, pharmaceuticals lived out within an aging society.

Therapeutic citizenship after morality: surviving the HIV epidemic in Ethiopia

HIV intervention during the last decade is marked by an enormous victory of the “universal treatment” strategy—that is, making antiretroviral therapy (ART) available to all patients worldwide. I argue in this paper that this strategy altered the moral premises of therapeutic citizenship in Africa in two significant ways. First, it swept away the “moral” approach that was effectively denying treatment access to HIV-positive people in low-income countries by insisting that “behavior change” was the only way to avoid contracting the virus and consequent deaths. However, as soon as universal treatment became the standard strategy to end the HIV pandemic, it started to erode the very moral ground on which access to treatment was sought—namely, concern for the suffering of others. The story of an HIV-positive woman who survived the HIV epidemic in Ethiopia demonstrates how rapid rollout of ART helped her break the silence and save her own life and that of many others. However, as the treatment intervention was increasingly captured by the local patriarchal political structures and the global logic of austerity, her efforts to attend to the suffering of her fellow patients became gradually undermined.