The Contingency of Humanitarianism: Moral Authority in an African HIV Clinic

The coloniality of power in Uganda's Nakivale Refugee Settlement: struggling for humanitarian authority amidst the 2018 corruption scandal

This paper addresses the complexity of studying the coloniality of humanitarianism and present-day relationships of power and authority in refugee settings. Building on 13 months of fieldwork, it presents an ethnographic account of the 2018 refugee corruption scandal in Uganda and the Nakivale Refugee Settlement. The core of this paper's argument is based on a grounded analysis of how 'the saga' not only exposed corruptive practices in the country's refugee programme, but also the meanings of being 'human' and what this implies for making claims to humanitarian authority. The paper asserts that the way in which the scandal unravelled in the (inter)national media, and how it affected sociopolitical tensions in the camp, revealed a deeply fraught conception of both human and humanitarian duality, embedded in a coloniality of power. Ultimately, power imbalances, frictions, and conflicts between national, international, and refugee actors highlighted a deep-rooted and historical struggle for humanity and legitimate humanitarian authority.

Relational Harm: On the Divisive Effects of Global Health Volunteering at a Hospital in Rural Zambia

Drawing on ethnographic research at a hospital in rural Zambia, I show how the presence of white Christian medical volunteers from the United States damaged relations between local health workers and patients. Working from a position of economic and racial privilege, medical volunteers received praise from many patients and residents. However, these positive attitudes incited resentment among many Zambian health workers who felt that their own efforts and expertise were being undervalued or ignored. Focusing on these disrupted relationships, I argue that it is crucial to understand how global health volunteering can produce enduring forms of "relational harm".

Humanitarian inversions: COVID-19 as crisis

COVID-19 is a multi-spectral crisis that has added an acute layer over a panoply of complex emergencies across the world. In the process, it has not only exposed actually-existing emergencies, but also exacerbated them as the global gaze has turned inward. As a crisis, COVID-19 straddles and challenges the boundaries between humanitarianism, development and global health - the frames and categories through which emergencies are so often understood and intervened upon. Reflection on these fundamental categories is, we argue, an important geographical endeavour. Drawing on Geoffrey Bowker's analytical lens of the 'infrastructural inversion', we explore how humanitarianism has been upended by Covid-19 along two axes that are of core concern to geographers: (1) the spatial; and (2) the temporal. We first contextualise current debates on the humanitarian endeavour and its future within recent geographical research. We then set out the complex structure by which COVID-19 has been both imagined and intervened upon as a humanitarian emergency. In so doing, we then pave the way for a deeper empirical analysis of the spatial and temporal inversions that have been brought forth by COVID-19. The paper concludes by examining the conceptual value of the 'inversion' in developing geographical research agendas better attuned to the increasing porosity of humanitarianism, development and global health.

The anthropology of health systems: A history and review

Ethnographies of health systems are a theoretically rich and rapidly growing area within medical anthropology. Critical ethnographic work dating back to the 1950s has taken policymakers and health staff as points of entry into the power structures that run through the global health enterprise. In the last decade, there has been a surge of ethnographic work on health systems. We conceptualize the anthropology of health systems as a field; review the history of this body of knowledge; and outline emergent literatures on policymaking, HIV, hospitals, Community Health Workers, health markets, pharmaceuticals, and metrics. High-quality ethnographic work is an excellent way to understand the complex systems that shape health outcomes, and provides a critical vantage point for thinking about global health policy and systems. As theory in this space develops and deepens, we argue that anthropologists should look beyond the discipline to think through what their work does and why it matters.

The Binds of Global Health Partnership: Working out Working Together in Sierra Leone

Global health partnerships (GHPs) are the conceptual cousin of partnerships in the development sphere. Since their emergence in the 1990s, the GHP mode of working and funding has mainly been applied to single-disease, vertical interventions. However, GHPs are increasingly being used to enact Health Systems Strengthening and to address the global health worker shortage. In contrast to other critical explorations of GHPs, we explore in this article how the fact, act, and aspiration of binding different actors together around the ideology and modes of partnership working produces the perpetual state of being in a bind. This is an original analytical framework drawing on research in Sierra Leone and London. We offer new insights into the ways in which GHPs function and are experienced, showing that along with the successes of partnership work, such arrangements are often and unavoidably tense, uncomfortable, and a source of frustration and angst.

Clinical ethics issues in HIV care in Canada: an institutional ethnographic study

BACKGROUND

This is a study involving three HIV clinics in the Canadian provinces of Newfoundland and Labrador, and Manitoba. We sought to identify ethical issues involving health care providers and clinic clients in these settings, and to gain an understanding of how different ethical issues are managed by these groups.

METHODS

We used an institutional ethnographic method to investigate ethical issues in HIV clinics. Our researcher conducted in-depth semi-structured interviews, compiled participant observation notes, and studied health records in order to document ethical issues in the clinics, and to understand how health care providers and clinic clients manage and resolve these issues.

RESULTS

We found that health care providers and clinic clients have developed work processes for managing ethical issues of various types: conflicts between client-autonomy and public health priorities ("treatment as prevention"), difficulties associated with the criminalization of nondisclosure of HIV positive status, challenges with non-adherence to HIV treatment, the protection of confidentiality, barriers to treatment access, and negative social determinants of health and well-being.

CONCLUSIONS

Some ethical issues resulted from structural disadvantages experienced by clinic clients. The most striking findings in our study were the negative social determinants of health and well-being experienced by some clinic clients - such as experiences of violence and trauma, poverty, racism, colonization, homelessness, and other factors affecting well-being such as problematic substance use. These negative determinants were at the root of other ethical issues, and are themselves of ethical concern.