Deconstructing diagnostics: a critical epidemiology of sleeping sickness in Uganda
(University of Edinburgh)
Paper short abstract:
Sleeping sickness manifests in hotspots of zoonotic configurations where multiple human, animal, insect, and public bodies become together in flux. This paper explores disease dynamics, diagnostics, and the data emerging at the interfaces between and beyond bodies through an ethnographic lens.
Paper long abstract:
This paper uses Human African Trypanosomiasis (HAT) as a case study to explore the connections and spaces between parallel 'formal' and 'informal' networks of HAT surveillance and control, and the parallel belief systems that motivate and influence the public body in ways that depart from biomedical norms within a decentralised health system in Northern Uganda. The extent to which 'networks' can be considered distinct from the knowledge systems that construct them will be contended by analysing the relational, circulatory forces that bring together bodies, pathogens, vectors, environments and infrastructures into configurations of disease states. At the individual level the 'body' is socially constructed in the same way 'bodies' or populations are problematised, targeted, and solved in ways that ascribe to the particular framework that conceives them. Non-conforming or 'defaulting' bodies are deemed as "ignorant", "stubborn", "illiterate", or "backward" when failing to comply with the dominant system in place. Discarding local and historically embedded knowledges fails to improve patient compliance nor case detection, and only serves to shift public health intervention efforts toward goal-oriented, measurable outcomes elsewhere and focus on cost-effective technological solutions such as rapid diagnostics and mobile data capture and diagnostic support tools. This paper will explore the concept of infrastructure in contested spaces of surveillance, and the ways in which current public health approaches to HAT control is deeply embedded within multiple epidemiological evidence bases at odds with local knowledge systems. Overlooking how these shape perceptions and behaviours leads to erroneous constructions of bodies with profound policy implications.
Non-conforming bodies: an exploration of public health knowledge, practice and technologies beyond 'the body'