by Beckie Marsland
Download your 25% discount voucher by clicking here: Biomedicine in an Unstable Place_CAP.
Download your 25% discount voucher by clicking here: Biomedicine in an Unstable Place_CAP.
PhD Multidisciplinary Studentship – Big Data, Health and Development
We are looking for an outstanding candidate to examine the role new forms of data are playing in shaping global health and development agendas.
As part of a new initiative by the Economic and Social Research Council (ESRC) we are offering a final studentship, to begin September 2013, to examine the role that a newfound emphasis on data is playing in terms of shaping global health and development priorities, policy and practice – with a particular emphasis on Neglected Zoonotic Diseases (NZDs) in Africa.
There is a discernible shift in terms of how we think about aid and its impacts. Debate is growing around the replacement for the Millennium Development Goals, aid effectiveness and how we measure impact. Influential actors such as the Bill and Melinda Gates Foundation are emphasising the need for proper data and quantifiable development targets. New approaches, often derived from public health, such as Randomised Controlled Trials and systematic reviews are increasingly seen as the gold standard for policymakers.
Nevertheless, this turn towards ‘Big Data’ in health and development is open to critique, about ignoring context, prompting approaches that can be quantified and putting power in the hands of fewer and fewer actors. This studentship will set out to explore the implications of and experiment with some of these emerging approaches (as well as adopting others such as social network analysis) – with particular reference to NZDs in Africa – and will contribute to an exciting cluster of research around health and development policy, based in the Centre of African Studies.
This studentship is fully-funded for four years and will provide an enhanced stipend (c. £15,000 per annum). We anticipate that successful applicants will already hold a masters degree in an appropriate area of study (for example in quantitative analysis, statistics, research methods or global health. These studentships are available to UK citizens.
To be considered please send a cv and cover letter to James Smith (firstname.lastname@example.org).
Professor James Smith
Chair of African and Development Studies
Assistant Principal, Global Development
University of Edinburgh
Tel: +44 (0)131 650 4321
For medical anthropologists wandering the streets of Edinburgh in search of inspiration –Surgeons’ Hall Museum on Nicholson Street is a goldmine of interesting historical artifacts, often linked to Edinburgh’s long academic involvement in the development of national medical practice. The museum has dedicated itself to archiving items of significance to that medical history, many of which are in the form of body parts chosen for their malfunctions or mishaps (gangrenous feet anyone?). These anatomical specimens are situated alongside exhibitions of the work which investigated and sometimes offered cures for these various pathologies.
The Penman Tumour
Last week I attended the museum for ‘Future Healthcare’ – a series of short workshops examining unusual artifacts from the Pathology Museum stores. Amongst these presentations, Ian Macintyre offered a history of ‘The Penman Tumour’’ that seemed particular poignant. The Pathology Museum hosts the dried and preserved remnants of this osteosarcoma, an enormous four and a half pound cancerous growth, set into the jaw of an unfortunate 19th century boot-maker – Robert Penman. A wooden cast of Penman’s head with the tumour intact sits alongside portraiture of the growth in situ, these having recently been rediscovered in the dusty cupboard of a residential house (beware spring cleaners!).
Penman bore the tumour for five and a half years, until, in 1828 his desperation for a cure convinced Edinburgh surgeon James Syme to attempt an excision. Testimony to a steady hand, Syme cut away the tumor with a scalpel, whilst the patient, awake and s up in a chair, endured the operation with only the heady assistance of hemlock. Nowadays the notion of such major surgery, which included the removal of part of the jaw would provoke a veritable hysteria of infection control procedures – miraculously however, the wound, packed with lint and heavily bandaged, healed within a matter of weeks. A portrait of Penman in later life, complete with a large beard to hide his facial disfigurement also part of the exhibition.
Medical nthropology as a discipline can be a little reticent in acknowledging successes in health improvements – perhaps because we are afraid of making assumptions about the propriety of practice or feel as if we would be imposing an impression of the superiority of one medical practice or another. The story of the Penman Tumour serve to remind me of the great assistance that biomedical technology has offered in relieving distress – advancements that presumably, James Syme would have found it difficult to imagine possible – the ability to carefully map the location of a tumour with remote imaging for instance, cutting into the body. Not to mention the fact that (in the UK at least – sadly not so in many other parts of the world) it would be highly unlikely that the cancer would have developed to the size of Penman’s deformity – such is the accessibility of medical surveillance services and early cancer treatment.
The Waterloo Teeth
I’ll offer one further note from the workshops – perhaps more of a personal fixation given my dislike of dentistry: Dr Paul Geissler, the museum’s dentistry conservator, offered some thoughts on the ‘Waterloo Teeth’ – not an artifacta phenomenon. Prior to the arrival of modern plastics, or the technology to shape porcelain, the eighteenth and nineteenth century public were plagued by mouths full of rotten and evil smelling gnashers. Dentures in the early days were commonly of bone, ivory or wood and very temporary solutions as they are porous and therefore rot quickly. A few of the very poor might be convinced to give up some of their own teeth in exchange for cash; or, with the right contacts it might be possible to obtain teeth from grave robbers or morticians – the price of a tooth from a corpse carrying up to (by todays figures) £100 a piece. Tooth rustling from graves was not technically illegal in the 18th century although not an ideal solution, as teeth drawn from the recently deceased carried a high risk of infecting the recipient with the same disease that carried off the donor.
For the struggling denturist The Battle of Waterloo in 1815 suddenly offered a grisly alternative – the fierce confrontation leaving tens of thousands of dead soldiers sprawled across open fields. Apparently their teeth were easy pickings for an aspiring tooth rustler with good pair of pliers. The removal of teeth from dead soldiers was such a successful venture that as late as 1860 teeth drawn from soldiers of the American Civil War were allegedly stowed in barrels and shipped to the UK. A set of Waterloo Teeth, complete with their gold plated denture surrounds are available to view at the museum.
Dr Geissler pointed out that in Scotland, blame for particularly horrendous teeth could often be laid at the door of the trade in sugar. As early as the 17th century Glasgow became a critical port stop in the ‘Triangular Trade’ of sugar, slaves and other goods running between the West Indies, Europe and West Africa. Perhaps unsurprisingly sugar was an instant hit with the on-shore Scottish populations, with disastrous consequences for dental health. If those unwholesome origins don’t put you off the traditional Scottish tablet (for those out of area – it’s a sort of fudge), then perhaps a glimpse of the nineteenth century drilling implements housed in the dentistry archive might do the trick.
Finally, if you’re not convinced by the ghoulish spectacle of preserved limbs – the development of surgery in the UK has been heavily influenced by surgeons trained in Edinburgh, many of whom have been immortalized in the 19th century portraiture hanging within the museums. Portraiture, particularly of medical professionals, in those days was quite severe – stern expressions, dimly lit backdrops and revelatory lighting. For those interested in artistic interpretations of medical professionals – compare these portraits with Ken Currie’s modern work ‘The Three Oncologists’ hanging in the Edinburgh National Portrait Gallery, I think it speaks volumes of the ambiguity of the medical practitioner, and particularly those who must deal with illnesses we associate with a life hanging in the balance: http://www.telegraph.co.uk/culture/culturepicturegalleries/8938711/The-Scottish-National-Portrait-Gallery-in-Edinburgh-reopens.html?image=9
If similar events would interest you, there are a number with focus on the history of medicine taking place in Edinburgh over the next few months:
‘Dissecting Edinburgh’ hosted by the Department of English Literature and Surgeons Hall Museum, the project aims to examine and raise the profile of Edinburgh’s strong historical links in both literature and medicine: https://sites.google.com/site/dissectingedinburgh/home
Surgeons Hall events and tours on website: http://www.museum.rcsed.ac.uk/content/content.aspx?ID=34
There have been so many great books published recently in medical anthropology that we have decided to revive the Medical Anthropology reading group. For our first meeting we will read Julie Livingston’s Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic.
Those of us in Edinburgh will meet on Wednesday 17th April from 1-2 pm, Meeting Room 4, Chrystal Macmillan Building. If you cannot be with us in person, we will post a summary of our discussion on the blog, and we hope you will join us by letting us know what you thought about the book in the comments.
The following books have been suggested for later meetings. Let us know if you have other recommendations!
Erin Koch, Free Market Tuberculosis
Siddhartha Mukherjee, The Emperor of All Maladies
Rachel Prentice – Bodies in Formation: An Ethnography of Anatomy and Surgery Education
Our colleagues Dominik Mattes, (Freie Universität Berlin) and Katerina Vidner Ferkov (University of Nova Gorica) from Medical Anthropology Young Scholars (MAYS) invite you to the 4th Annual Meeting “Impediments and Catalysts” in Tarragona, Spain, 10-11 June 2013. The meeting will precede the joint international conference “Encounters and Engagements” organized by the AAA Society for Medical Anthropology/EASA Medical Anthropology Network/Universitat Rovira I Virgili (more info at http://easaonline.org/networks/medical/events.shtml).
Deadline for abstract submission is 15 February 2013.
Please download and circulate the flyer: MAYS CFP, 2013, Tarragona_final_07-12-2012
I’ve recently returned from a long period of fieldwork in Rwanda, examining the exhumation and ‘reburial’ of human remains within mass graves. My work draws on themes of focus within medical anthropology and I’ve been enjoying the blog contributions from the medical anthropology community here at Edinburgh.
The text and images below were kindly forwarded by Kate Doyle after I recalled her showing me the pictures upon her return from Lake Bunyonyi. The lake sits within a remote and beautiful area of Uganda, situated just over the border from Rwanda. I hope you also find the photographs thought provoking.
Laura Major (PhD candidate, Dept Social Anthropology)
Kate Doyle graduated from the MSc in the Anthropology of Health and Illness at Edinburgh in 2008. She is currently a consultant working on gender and HIV in Rwanda. She writes:
The photos you see were taken during a visit to a secondary school located on a small island in Uganda’s Lake Bunyoni, The headmaster was very proud of what he called their “talking campus,” with these small signs dotting the pathways between the classrooms and dormitories.
The signs illustrate the strong impact that ‘ABC’ – abstinence, be faithful, condomise – HIV prevention campaigns. In Uganda, ABC has seen a considerable focus on promoting abstinence only, especially for young people. This focus has drawn considerably criticism from health and human rights organizations in recent years.
The messages do however indicate an openness to discussing sex, sexuality and HIV with young people. In neighboring Rwanda, where I work, such discussion is still considered very taboo – which is a challenge for HIV prevention in a country where the majority of the population is aged below 25 years.
By Tom Capon and the Student Stop AIDS Society
We’d like to introduce our society, which may be of interest to the University’s medical anthropologists. Student Stop AIDS Edinburgh is part of a national campaign to bring an end to the injustice of the HIV/AIDS pandemic. We raise awareness through public engagement, and lobby governments and corporations with the aim of forcing strong action with regards to HIV prevention, treatment, care and support. The society is an active and passionate group on campus with regular events and campaigns.
At the time of writing, a group of our members has just returned from the annual AGM, this year held in Sheffield, where campaigns and ideas were discussed for the year ahead in an inspired and lively atmosphere. The campaigns for this year include encouraging Johnson & Johnson to join the Patent Pool, which would enable affordable generic ARV drugs to be manufactured. Their entrance is crucial to the success of this initiative, yet they are stalling, putting profits above their social responsibilities. We also campaign to ensure that vital treatment and prevention programmes in the developing world are fully funded, and we support sexual health campaigns in the UK. To further these campaigns, we have been working on our political lobbying and our street campaigning skills, as well as building links with related groups.
Preparations also continue towards a week of events to mark World AIDS Day (1st December). An extensive presence on campus is to be expected! We will be screening Larry Clark’s controversial 1995 film ‘Kids’ at the Brass Monkey (27th November) and, not to be missed, our annual fundraiser, CabarAIDS, at Malone’s (29th November), where a wide variety of performers will put on a delightful evening of entertainment, all in the name of charity! This event has been hugely successful in the past and even won EUSA’s ‘Best Event’ Award last year!
Whilst the society has a serious mission, we are friendly, fun-loving and always open to new members. We imagine that our interest in global public health, intellectual property reform and global justice mirror many of the concerns of medical anthropologists at the University, and we’d love to hear from anyone who’d like to find out more. Our weekly meeting is at the Greenmantle, Thursdays, 7pm, and you can get in touch with us at email@example.com
Last week, Jeroen Jansen of Médicins Sans Frontières, spoke at the RHID seminar on “Operating in a Gap: Humanitarian Emergency Aid in Complex Political Circumstances”.
He argued that the definition of “complex emergencies” is unhelpful for agencies whose mandate is to focus on the need that these emergencies create on the ground. The most widely used definition is that proposed by the Inter Agency Standing Committee in 1994:
a humanitarian crisis in a country, region or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single agency and/ or the ongoing United Nations country program.
According to Jansen, this definition is detrimental to the ability of humanitarian agencies to respond to the need of people affected by complex emergencies. Firstly, following the argument of David Keen, defining complex emergencies in terms of a “breakdown of authority” is misleading, both in our ability to understand the emergency situation and in terms of protecting the populations involved. Keen’s argument is that different actors benefit from war – for example both governments and rebels. So, the “breakdown of authority” definition effectively puts governments and other actors out of the picture, leaving them free to take advantage of the emergency situation and even manipulate the humanitarian assistance according to their own agenda. Secondly the IASC definition focuses on the international response, which means that our attention is directed away from the complex picture on the ground.
Drawing on his own experience in South Sudan, Jansen illustrated the gaps that have appeared in the world of humanitarianism. There is the funding gap (closely related to the CNN effect) – money can be designated to cover activities that donors have prioritized, rather than responding to need. MSF had been in South Sudan since 1984 and when the country became independent there was no funding allocated to cover the work that MSF had being doing. The governance gap can mean that a country is effectively governed by international NGOs for years so that when a new government, like that in South Sudan, takes over they have little or no experience. Devastatingly there can be a protection gap: after a peace agreement is signed then both the state and the United Nations can find themselves impotent. In South Sudan in 2009 over 1000 men and women were massacred in Jonglei, and there was no-one to protect them. The UN had no mandate to act and the Sudan People’s Liberation Movement who dominated the new government of South Sudan were unable to control their own security forces – the Sudan People’s Liberation Army, which by then had taken in formerly hostile militia (Human Rights Watch Report 2009, “The Way Forward”).
This leads us to what Jansen described as the Meron effect. In the “Humanisation of International Law” (2006) Theodore Meron, the Director of the International Criminal Tribune for the former Yugoslavia, analysed the overlap between international humanitarian law and international human rights law. Jansen explained that international humanitarian law applies only when there is a war and international human rights law begins when peace has been established. The period between war and peace is not covered by either – and only non-derogable human rights apply. This is the space where the gaps are formed. The response of the aid agencies to this is all too often to engage in nonproductive arguments about which system of law applies to the situation, meaning that once again attention and energy is focused on the complexity of the intervention rather than the complexity of the context of the people who need medical and other humanitarian assistance.