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Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic, by Julie Livingston
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In Improvising Medicine, Julie Livingston tells the story of Botswana's only dedicated cancer ward, located in its capital city of Gaborone. This affecting ethnography follows patients, their relatives, and ward staff as a cancer epidemic emerged in Botswana. The epidemic is part of an ongoing surge in cancers across the global south; the stories of Botswana's oncology ward dramatize the human stakes and intellectual and institutional challenges of an epidemic that will shape the future of global health. They convey the contingencies of high-tech medicine in a hospital where vital machines are often broken, drugs go in and out of stock, and bed-space is always at a premium. They also reveal cancer as something that happens between people. Serious illness, care, pain, disfigurement, and even death emerge as deeply social experiences. Livingston describes the cancer ward in terms of the bureaucracy, vulnerability, power, biomedical science, mortality, and hope that shape contemporary experience in southern Africa. Her ethnography is a profound reflection on the social orchestration of hope and futility in an African hospital, the politics and economics of healthcare in Africa, and palliation and disfigurement across the global south.
- Sales Rank: #97794 in Books
- Published on: 2012-08-29
- Original language: English
- Number of items: 1
- Dimensions: 9.20" h x .60" w x 6.10" l, .75 pounds
- Binding: Paperback
- 248 pages
Review
“Improvising Medicine is a luminous book by a highly respected Africanist whose work creatively bridges anthropology and history. A product of intense listening and observation, deep care, and superb analytical work, it will become a canonical ethnography of medicine in the global south and will have a big impact across the social sciences and medical humanities.”—Jo�o Biehl, author of Will to Live: AIDS Therapies and the Politics of Survival and Vita: Life in a Zone of Social Abandonment
"Improvising Medicine is as good as it gets. It is a book that will be read for decades to come. I have always thought that great ethnography transcends the specificities of time and place, of the particular, to offer a glimpse of the universal. This gripping book does just that, and the subtle and grounded way that it speaks to global health and debates in medical anthropology makes it a major addition to both fields."—Vinh-Kim Nguyen, M.D., author of The Republic of Therapy: Triage and Sovereignty in West Africa's Time of AIDS
“This book will find a ready readership among Africanists and medical anthropologists. I envision its wider use in g'lobal health' courses, where it will challenge aspiring health workers accustomed to locating hope for medical development in scalable technical interventions... Cancer care, Livingston shows us—like medicine, like development—often requires starting over, usually entails improvisation, and always calls for hard labor by particular individuals in the face of destructive political and economic forces. Improvising Medicine reminds us effectively, sometimes devastatingly, how intractably human this thing called 'health care' is.” (Claire Wendland American Ethnologist)
“This is an excellent ethnography that should (and undoubtedly will) be read and taught by anthropologists, historians, science studies scholars, and interdisciplinary scholars of Africa…. students and practitioners of global health should be reading Improvising Medicine, in which African cancer is made visible and the clinical science of oncology is never divorced from the moral labor and political conditions of care.” (Johanna Crane African Studies Review)
“Improvising Medicine is best suited to those who are interested in global health or who provide medical care across cultures. While its primary subject is cancer, the points the author makes regarding the view of medical care priorities in resource-poor countries, as well as the culture-dependent experience of disease, are well taken and can be applied to work in other areas of the world.” (Holly Salzman Family Medicine)
“In Improvising Medicine, Julie Livingston presents a vivid ethnography of cancer management in an African hospital ward...This book is rich in textual and visual data and is theoretically well informed. It is a model of ethnographic work and an excellent monograph in global medicine and health systems research.” (Benson Mulemi Social History of Medicine)
“Although this scholarly work explores a harsh and distressing reality, it is well written, with a warmth and compassion that will make it accessible and appealing to a broad readership… This book will have a direct and sustained impact across fields of social sciences and medical humanities – as it can provide an important perspective often lacking within the paternalistic global health debates.” (Karen Barnes Journal of Southern African Studies)
“Improvising Medicine is an exquisite ethnography, replete with both specific, richly observed encounters at a cancer ward in Botswana and broader, urgent arguments for anthropology and global health. . . . Drawing on beautifully rendered ethnographic evidence, Improvising Medicine tells a compelling story that is relevant for anthropology and beyond.” (Anne Pollock Journal of Anthropological Research)
“That Improvising Medicine is at times difficult to read is a testament to Livingston’s observational and storytelling skills, her ability to allow us to imagine what it might feel like to be a patient, caregiver, nurse, or doctor in an African hospital. This is a remarkable book that deserves and will surely attract a wide readership.” (Neil Kodesh Journal of African History)
"Improvising Medicine is a brilliant and groundbreaking hospital ethnography, one that grips the reader with its narratives of an institution characterized by constant precarity, where supplies, medications, procedures, and staff are never assured.... Improvising Medicine should interest diverse audiences. These include medical anthropologists, sociologists, social historians of Africa, public health specialists, and scholars across disciplines with interest in the cultures and practices of biomedicine, the morality of care, and the comparative analysis of medical ethics." (Carolyn Sargent Medical Anthropology Quarterly 2016-06-14)
About the Author
Julie Livingston is Associate Professor of History at Rutgers University. She is the author of Debility and the Moral Imagination in Botswana and a coeditor of Three Shots at Prevention: The HPV Vaccine and the Politics of Medicine's Simple Solutions and A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship.
Most helpful customer reviews
4 of 4 people found the following review helpful.
powerful, insightful view on cancer in Botswana
By John Snow
"Improvising Medicine" is an insightful, deeply touching book about cancer, life, laughter and humanity. This is not a story of heroic doctors finding innovative 'solutions' to 'African' health problems, it is about people facing disease, pain and uncertainty in ways that are universal and individual.
3 of 3 people found the following review helpful.
touching and human
By HJC
This was an incredibly moving book that was difficult to read in parts, but also tremendously touching and human. I feel like I have a better understanding of the strength of the human spirit but also the debilitating toll to the body that cancer can take. I never knew that it was the rot and shame of cancer that caused generations ahead of mine to whisper "The Big C" but now I get it. I also appreciated how beautifully human and even funny the retelling of events and personal stories were by this talented author.
2 of 2 people found the following review helpful.
Dynamite account of Botswana cancer hospital
By Spring Texan
Anyone interested in medical anthropology can use this thoughtful and observant book. Livingston is the daughter of an oncologist and she states in the introduction: "In the face of many deaths I have witnessed since childhood, I have also questioned oncology's rituals, its liturgy, and the excesses to which blind faith and desperation can lead. . . . [In Botswana] I came to understand that while cancer with oncology was awful, cancer without oncology could be obscene."
She puts the things she observes in the context of rising cancer rates in Africa and general unavailability of treatment, especially given forced-by-IMF privatization and expensive cancer drug patents. In a still-public hospital in Botswana which at least has an ethos of caring and an excellent oncologist, Livingston is, as she realizes, in one of the better possible settings in the environment, but the hospital staff struggles mightily with limited resources, hordes of patients, lack of treatment drugs and palliative drugs, and in general tremendous difficulties. How the patients and the staff manage and conceptualize things is astutely observed.
Yet at the end the book leaves me touched, yes, but also angry about the marginalization of African health care and disease and about the drug patent system, as well as somewhat frustrated at how ephemeral any local gains can be without any sort of steady or rational progress, but grateful for people who are willing to deal with things as best they can regardless of that. And grateful for this fine book.
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