Para-States and Medical Science

Making African Global Health

Para-States and Medical Science

Critical Global Health: Evidence, Efficacy, Ethnography

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Book Pages: 376 Illustrations: 14 illustrations Published: January 2015

African Studies, Anthropology > Medical Anthropology, Medicine and Health > Global Health

In Para-States and Medical Science, P. Wenzel Geissler and the contributors examine how medicine and public health in Africa have been transformed as a result of economic and political liberalization and globalization, intertwined with epidemiological and technological changes. The resulting fragmented medical science landscape is shaped and sustained by transnational flows of expertise and resources. NGOs, universities, pharmaceutical companies and other nonstate actors now play a significant role in medical research and treatment. But as the contributors to this volume argue, these groups have not supplanted the primacy of the nation-state in Africa. Although not necessarily stable or responsive, national governments remain crucial in medical care, both as employers of health care professionals and as sources of regulation, access, and – albeit sometimes counterintuitively - trust for their people. “The state” has morphed into the “para-state” — not a monolithic and predictable source of sovereignty and governance, but a shifting, and at times ephemeral, figure.  Tracing the emergence of the “global health” paradigm in Africa in the treatment of HIV, malaria, and leprosy, this book challenges familiar notions of African statehood as weak or illegitimate by elaborating complex new frameworks of governmentality that can be simultaneously functioning and dysfunctional.

Contributors. Uli Beisel, Didier Fassin, P. Wenzel Geissler, Rene Gerrets, Ann Kelly, Guillaume Lachenal, John Manton, Lotte Meinert, Vinh-Kim Nguyen, Branwyn Poleykett, Susan Reynolds Whyte


Para-States and Medical Science is an exceptional and engaging book that will be of interest to anthropologists, Africanists and historians as well as those interested in science and technology, post-colonial and development studies.” — Mary-Anne Decatur, Anthropology Book Forum

"Individual chapters focus specifically on processes of medical research, not health care delivery, but in so doing provide an often overlooked perspective on the types of medical work undertaken in Africa.... Summing up: Recommended." — M. M. Heaton, Choice

"Headed by a conceptually rich and well-argued introduction, the collection contains eleven strong contributions, all of which present original empirical case studies on diverse topics of public health intervention and research in African countries, ranging from history to social anthropology.... This collection offers a fresh interpretation of the paradigm of bio-governmentality, the discussion on the nation state in neo-liberal condition, and the project of development in the context of globalisation of African societies." — Astrid Bochow, Allegra Lab

"This volume is a crucial read for those interested in medical anthropology, science and technology studies, HIV/AIDS research and treatment, malaria, public health, development, and policy making and will be useful for graduate courses on these topics as well as those focused on Africa, globalization, neoliberalism, and the nationstate.... Geissler created a provocative account of medical science and health care, which not only contributes to scholarly discussion, but also to public debates about foreign funded treatment programs and research, which benefit from clinical trials, and the development of new drugs and their side effects." — Cortney Hughes Rinker, Anthropos

"I highly recommend this volume for anyone interested in the social relations of biomedicine, and particularly biomedical research, in Africa. As an interdisciplinary anthropologist who works on this topic, I found the book’s provocation to pay attention to the persistence of the African state extremely useful—suddenly, I am seeing the state in places in my work that I had formerly overlooked. I also appreciated this volume’s empirical documentation of the numerous ways in which, despite persistent inequalities, African actors—states, institutions, and individuals—shape global health partnerships and the knowledge they produce." — Johanna Crane, Medical Anthropology Quarterly

"Para-States and Medical Science is an impressive volume and a welcome addition to work on critical global health in Africa. The collection provides a much needed re-reading of contemporary biopolitical regimes in Africa, which neither fit old models of biopower nor conform to neoliberal forms found elsewhere. ... this work makes an original and innovative contribution to scholarship on the shifting relations between state, public, private and corporate interests in health care in Africa, and makes inroads for anthropologists, historians and STS scholars to move beyond standard narratives of 'development' and 'neoliberalism' in African contexts." — Michelle Pentecost, New Genetics and Society

"Overall, thanks to the use of 'para-state' as an analytical concept, the collection adds to our knowledge of the evolution of the postcolonial state and its predicaments as well as the role played by nonstate actors." — Kalala Ngalamulume, Journal of the History of Medicine

"The volume should become mandatory reading for scholars and students interested in the new configurations and possibilities that emerge on the African continent in the context of medical globalization, and which demonstrate (once more) that rigid distinctions between the global, national and local, public and private, state and non-state have become untenable, if not useless." — Hansjörg Dilger, Africa

"Para-States and Medical Science brings together an impressive group of anthropologists, historians, and STS scholars to provide a fine-grained assessment of crucial transformations in African health care and in the relationship between states, publics, knowledge production, and private interests. It is a welcome corrective to any bland caricature of 'neoliberalism' that fails to take account of the state in satisfactory ways. This collection marks a turning point." — Julie Livingston, author of Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic

"This outstanding book introduces and interrogates an innovative concept, the 'para-state', while also presenting rich, textured, stimulating work in original ethnography set in Africa.  Its publication will be welcomed by a wide range of Africanists, historians and anthropologists of medicine and science, and those interested in development and postcolonialism in the Global South."
— Nancy Rose Hunt, author of A Colonial Lexicon: Of Birth Ritual, Medicalization, and Mobility in the Congo


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Author/Editor Bios Back to Top

P. Wenzel Geissler is Professor of Social Anthropology at the University of Oslo. He is the coauthor (with R. J. Prince) of The Land Is Dying and coeditor of a number of books, including Evidence, Ethos and Experiment.

Table of Contents Back to Top
Introduction: A Life Science in Its African Para-State / P. Wenzel Geissler 1

Part I: Rupture, Continuity

1. Treating to Prevent HIV: Population Trials and Experimental Societies / Vinh-Kim Nguyen 47

2. Trialing Drugs, Creating Publics: Medical Research, Leprosy Control, and the Construction of a Public Health Sphere in Post-1945 Nigeria / John Manton 78

Part II: Pasts, Futures

3. Lessons in Medical Nihilism: Virus Hunters, Neoliberalism, and the AIDs Crisis in Cameroon / Guillaume Lachenal 103

4. What Future Remains? Remembering an African Place of Science / P. Wenzel Geissler 142

Part III: State Remains

6. International Health and the Proliferation of "Partnerships": (Un)Intended Boost for State Institutions in Tanzania? / Rene Gerrets 179

6. Working and Surviving: Government Employees on ART in Uganda / Susan Reynolds Whyte 207

Part IV: Affective Wholes

7. Molecular and Municipal Politics: Research and Regulation in Dakar / Branwyn Poleykett 237

8. The Work of the Virus: Cutting and Creating Relations in an ART Project / Lotte Meinert 257

Part V: Struggling Nation

9. The Blue Warriors: Ecology, Participation, and Public Health in Malaria Control Experiments / Ulrike Beisel 281

10. The Territory of Medical Research: Experimentation in Africa's Smallest State / Ann H. Kelly 303

11. Adventures of African Nevirapine: The Political Biography of a Magic Bullet / Didier Fassin 333

Contributors 355

Index 357
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Additional InformationBack to Top
Paper ISBN: 978-0-8223-5749-0 / Cloth ISBN: 978-0-8223-5735-3
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