Biomedicine in an Unstable Place

Infrastructure and Personhood in a Papua New Guinean Hospital

Biomedicine in an Unstable Place

Experimental Futures

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Book Pages: 304 Illustrations: 13 illustrations Published: October 2014

Author: Street, Alice

Anthropology > Medical Anthropology, Medicine and Health > Global Health, Science and Technology Studies

Biomedicine in an Unstable Place is the story of people's struggle to make biomedicine work in a public hospital in Papua New Guinea. It is a story encompassing the history of hospital infrastructures as sites of colonial and postcolonial governance, the simultaneous production of Papua New Guinea as a site of global medical research and public health, and people's encounters with urban institutions and biomedical technologies. In Papua New Guinea, a century of state building has weakened already inadequate colonial infrastructures, and people experience the hospital as a space of institutional, medical, and ontological instability.

In the hospital's clinics, biomedical practitioners struggle amid severe resource shortages to make the diseased body visible and knowable to the clinical gaze. That struggle is entangled with attempts by doctors, nurses, and patients to make themselves visible to external others—to kin, clinical experts, global scientists, politicians, and international development workers—as socially recognizable and valuable persons. Here hospital infrastructures emerge as relational technologies that are fundamentally fragile but also offer crucial opportunities for making people visible and knowable in new, unpredictable, and powerful ways.


"Street’s work is a welcome intervention that nuances our understandings of personhood, materiality and the everyday workings of biomedicine in a postcolonial context. A clear and articulate ethnography, Biomedicine in an Unstable Place will be of interest to undergraduate and graduate students, as well as professionals in the fields of medical anthropology, science and technology studies, history of medicine and global health." — Gabriela Elisa Morales, Social Anthropology

“Scholars of Papua New Guinea and Melanesia will naturally welcome this extraordinary book. It should also be read by those with an interest in ontology, post-colonial science, the anthropology of infrastructure, and the anthropology of the state." — Barbara Andersen, Anthropological Quarterly

“This valuable ethnography will interest anthropologists of biomedicine, scholars of Melanesia, and the many social scientists and students involved in global health. It helps readers move beyond global/local, universal/particular binaries to understand how biomedicine functions in a world full of unstable places.”  — Claire L. Wendland, Journal of Anthropological Research

Biomedicine in an Unstable Place is an important text of impressive quality. The volume makes a valuable contribution to Melanesian studies, medical anthropology, and postcolonial studies. More importantly, as Street notes in her introduction, most of the world’s people now encounter biomedicine in ‘peripheral institutions’ like Madang Hospital; more attention to the forces at work in such places is warranted.” — Courtney Addison, Medicine Anthropology Theory

“Street’s contribution to medical anthropology and science and technology studies lies in her skilful analysis of the multiplicity of hospital spaces. She offers one of the finest examples of how to write hospital ethnography by articulating spatial and temporal frictions, overlaps and shifts in medical knowledge and practice. By contextualising the contradictions and paradoxes running through public health development in a poor part of the world, Street is able to provide crucial insight into people’s hopes and disappointments as they are invested in biomedical care. Biomedicine in an Unstable Place is not only instructive for anthropologists interested in the improvised nature of medicine and care in contexts of economic scarcity but also for public health workers and development aid providers who work or are planning to work in Papua New Guinea.”   — Bo Kyeong Seo, The Asia Pacific Journal of Anthropology

"Anyone interested in understanding the challenges faced by public hospitals will profit from the incisive, empathic, and compelling insights of this superb study."  — John Barker, Pacific Affairs

"This excellent book is a compelling and often moving ethnography. It makes an original contribution to medical anthropology and the anthropology of the state, institutions, and infrastructure. Biomedicine in an Unstable Place also advances the anthropological study of personhood, Christianity, race, and class. The elegance of Street’s prose together with her satisfying and succinct analysis of so many complex and urgent issues will make Biomedicine in an Unstable Place an outstanding teaching resource." — John Cox, American Anthropologist

"[This books] makes an enormous contribution to Melanesian ethnography, is an exciting and exemplary use of STS theory, and is a path-breaking analysis of how hospitals work and don’t work in a postcolonial context." — Holly Wardlow, Medical Anthropology Quarterly

"The book is most compelling when it combines insights from the fields of New Melanesian Ethnography and medical anthropology to show how social inequalities present as differential possibilities of care within the hospital. The elusiveness of recovery in this space contributes to patients' profound anxieties about being properly recognized and acted upon by other actors within and outside the hospital." — Mackenzie Cramblit, Somatosphere

"[A] valuable read for those seeking a case-based introduction to medical anthropology and to global health." — William Cayley Jr., Family Medicine

"In a sense, this rich, but unsettling, ethnography demonstrates how a biomedical bureaucracy and governmentality became and are still becoming Melanesian. As such, Street’s new book takes a rightful place among other recent ethnography on postcolonial modernity in [Papua New Guinea]." — David Lipset, Anthropological Forum

"This study will be enthusiastically welcomed by (medical) anthropologists and historians, and by students who can learn from it how to interweave ethnography with theory." — Sjaak van der Geest, Bulletin of the History of Medicine

"Biomedicine in an Unstable Place is fresh, nuanced, and well written; it reinvigorates the hospital as a crucial research site. It is written with a keen eye toward continuities and transformations over space and time." — Cristina T. Bejarano, American Ethnologist

"Biomedicine in an Unstable Place is a superb study of vital importance. Alice Street shows us what 'global health' really means on the ground, in practice. Her wonderfully perceptive account reveals how medical personnel seek, and sometimes achieve, distinctively modern identities, and how patients yearn for recognition and cure, but often remain invisible to biomedical technology and the hospital bureaucracy. Scholars interested in global health, medical anthropology, and science studies have been waiting for just this sort of hospital ethnography for a long time."
— Warwick Anderson, author of The Cultivation of Whiteness: Science, Health, and Racial Destiny in Australia

"This compelling study achieves almost perfect pitch in the way it engages quite different sources of understanding. At once true to the locale of a hospital in the Pacific and to the world of institutions just round everyone's corner, it also conveys the unexpected accommodations that patients and staff alike have to make to the predicaments in which they find themselves. Closely observed, sympathetic, critical, this is contemporary ethnography of the first order."
— Marilyn Strathern, University of Cambridge


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Author/Editor Bios Back to Top

Alice Street is a Chancellors Fellow in Social Anthropology in the School of Social and Political Science at the University of Edinburgh.

Table of Contents Back to Top
Acknowledgments ix

Prologue 1

Part I. Place

1. Making a Place for Biomedicine 11

2. Locating Disease 39

3. Public Buildings, Building Publics 59

Part II. Technology

4. Doctors without Diagnosis 89

5. The Waiting Place 115

6. Technologies of Detachment 143

Part III. Infrastructure

7. The Partnership Hospital 169

8. Research in the Clinic 194

Conclusion: Biomedicine in a Fragile State 223

Notes 237

Bibliography 261

Index 281
Sales/Territorial Rights: World

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Additional InformationBack to Top
Paper ISBN: 978-0-8223-5778-0 / Cloth ISBN: 978-0-8223-5761-2
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