Vincanne Adams

Randomized controlled crime: Postcolonial sciences in alternative medicine research

The ambiguous terrain of ‘fact-making’ in biomedical clinical research is explored by way of an investigation of the criminalization of Tibetan medicine and Tibetan medical practitioners who participate in the global pharmaceutical pursuit of new medical products. Transcultural encounters between biomedical research interests and Tibetan medical practitioners suggest the production of awkward alliances between the state, markets, and measures of medical efficacy on an uneven global playing field. Moving beyond the possibility that a postcolonial science will be inherently hybrid, this paper seeks to uncover the inequalities of such hybrid-making encounters. When ‘medical facts’ must be derived from ‘magical beliefs’ in the centres of biomedical science, the state often intervenes to criminalize practitioners of alternative medicine. But, when profits are to be made on the fact that ‘the magical’ sells in alternative medicine, the state also makes it possible to shift ownership of medical knowledge, sometimes by way of the randomized controlled trial and the pursuit of active ingredients. The possibility of relocating the label of ‘crime’ is explored in this paper by way of an inquiry into processes that enable this shift in ownership, and a relocation of what constitutes medical ‘fact’ versus‘belief’.

Global Health Diplomacy

A variety of shifts emergent with globalization, which are reflected in part by nascent programs in “Global Public Health,” “Global Health Sciences,” and “Global Health,” are redefining international public health. We explore three of these shifts as a critical discourse and intervention in global health diplomacy: the expansion in non-governmental organization participation in international health programs, the globalization of science and pharmaceutical research, and the use of militarized languages of biosecurity to recast public health programs. Using contemporary anthropological and international health literature, we offer a critical yet hopeful exploration of the implications of these shifts for critical inquiry, health, and the health professions.

Sex in Development: Science, Sexuality, and Morality in Global Perspective

Sex in Development examines how development projects around the world intended to promote population management, disease prevention, and maternal and child health intentionally and unintentionally shape ideas about what constitutes “normal” sexual practices and identities. From sex education in Uganda to aids prevention in India to family planning in Greece, various sites of development work related to sex, sexuality, and reproduction are examined in the rich, ethnographically grounded essays in this volume. These essays demonstrate that ideas related to morality are repeatedly enacted in ostensibly value-neutral efforts to put into practice a “global” agenda reflecting the latest medical science. Sex in Development combines the cultural analysis of sexuality, critiques of global development, and science and technology studies. Whether considering the resistance encountered by representatives of an American pharmaceutical company attempting to teach Russian doctors a “value free” way to offer patients birth control or the tension between Tibetan Buddhist ideas of fertility and the modernization schemes of the Chinese government, these essays show that attempts to make sex a universal moral object to be managed and controlled leave a host of moral ambiguities in their wake as they are engaged, resisted, and reinvented in different ways throughout the world. Contributors. Vincanne Adams, Leslie Butt, Lawrence Cohen, Heather Dell, Vinh-Kim Nguyen, Shanti Parikh, Heather Paxson, Stacy Leigh Pigg, Michele Rivkin-Fish

Having A “Safe Delivery”: Conflicting Views from Tibet

In the Tibetan Autonomous Region (TAR) of the Peoples Republic of China (PRC) maternal mortality ratios remain among the highest in the world. Although traditional Tibetan medical theory, practice, and pharmacology include information on maternal and child health care, Tibet is one of the few societies in the world that does not have traditional birth attendants or midwives. Using ethnographic methods, we gathered data from individual interviews with rural Tibetan women (N = 38) about their beliefs and behaviors surrounding pregnancy and childbirth. Additional data were gathered through interviews with prefecture, county, and township health care providers. These data were used to develop a culturally appropriate village birth attendant training program in rural Tibet. We describe Tibetan womens perspectives of “having a safe delivery” in relation to concepts about “safe delivery” according to evidence-based medicine in the West. Our work also provides an example of the benefits and challenges that arise when ethnographic research methods are used to design and implement health care interventions.

Aging Disaster: Mortality, Vulnerability, and Long-Term Recovery Among Katrina Survivors

Data from this multiyear qualitative study of the effects of Hurricane Katrina and flooding in New Orleans suggest differences in how the elderly cope with disaster. At the time of the disaster, the elderly of New Orleans were at greater risk than other groups, and more elderly died than any other group during the storm and in the first year after. Those who did survive beyond the first year report coping with the long-term disaster aftermath better than the generation below them, experiencing heightened stresses, and feeling as if they are “aging” faster than they should. We offer insight on how we might define and characterize disasters, and illustrate that long-term catastrophes “age” in specific ways.

Tourism and Sherpas, Nepal: Reconstruction of reciprocity

Abstract Despite nearly 40 years of involvement in tourism and its heavy demands for wage labor, Nepalese Sherpas have found ways to reconstitute traditional productive relations in their new economy. This article takes a cultural approach to tourism capitalism. Sherpa reciprocal labor in the form of kinship, and other types of exchanges, has been reconstituted in mountain tourism alongside well-established patterns of wage labor. It is suggested that the Sherpa logic that informs and shapes Sherpa economic endeavors is a cultural logic revolving around tendencies toward both independence and interdependence into which new tourism opportunities can fit.

Slow Research: Thoughts for a Movement in Global Health

Slow research, like slow food, is good for health.The impetus for this article arises from a shared desire for rethinking our approach to Global Health. The field of Global Health, arising from the...

GROWTH OF TOURISM IN NEPAL'S EVEREST REGION: IMPACT ON THE PHYSICAL ENVIRONMENT AND STRUCTURE OF HUMAN SETTLEMENTS

The annual influx of several thousand tourists into Nepals Khumbu region, where Mount Everest and other well-known peaks are located, has created various demands on the limited natural resources of the area. It has resulted also in substantial tourist- related construction in the district capital, Namche Bazar. Between the early 1970s and the 1980s, the annual number of tourists visiting Khumbu rose from a few hundred to several thousand. Despite the substantial fuel requirements of this large visitor population, additional damage to the regions already partially denuded forests has been avoided by requiring all visitors to import their own fuel for cooking purposes. Local monitoring of tourist activities is made possible through the Sagarmatha (Everest) National Park whose Headquarters are located at Namche Bazar; the Park programmes include enforcement of wood-cutting regulations, trail and bridge maintenance, and upkeep of a visitor centre and research library. Continued involvement of local village government in Park management decisions seems essential if current problems, such as waste management, are to be resolved.

Public health works: Blood donation in urban China☆

Recent shifts in the global health infrastructure warrant consideration of the value and effectiveness of national public health campaigns. These shifts include the globalization of pharmaceutical research, the rise of NGO-funded health interventions, and the rise of biosecurity models of international health. We argue that although these trends have arisen as worthwhile responses to actual health needs, it is important to remember the key role that public health campaigns can play in the promotion of national health, especially in developing nations. Focusing on an example set by China in response to a public health crisis surrounding the national need for a clean and adequate blood supply and the inadvertent spread of HIV by way of blood donation in the early 1990s, we argue that there is an important role for strong national public health programs. We also identify the key factors that enabled Chinas response to this burgeoning epidemic to be, in the end, largely successful.

Saving Tibet? An Inquiry into Modernity, Lies, Truths, and Beliefs

Social theorists have explored the ways in which quantification serves as an instrument of governance in the modern state, whether tied to concerns of population size and quality or to problems of social behavior. Biopolitics are as visible in the modern socialist states as they are in free-market democratic states, and they are perhaps nowhere more visible today than in the new global standards of “evidence-based medicine,” wherein it is assumed that only quantifiable evidence can serve to establish policy, procedure, and outcome. When it comes to creating ways to “civilize” and organize their target citizenry through health development, Socialist China has relied on such technologies as much as have health development funding agencies from donor countries. In this article, I look at quantitative methods in relation to assumptions that morality can be severed from truth and that numbers are potentially morally neutral. This idea is tied not only to forms of modern subjectivity but also to the distinct ways in which certain linguistic and theoretical practices relate to provisional notions of “lying,” “truth-telling,” and ways of “believing.” An exploration of the effects of attempts to quantify maternal behavior, morbidity, and mortality in rural Tibet highlights the problem of morality within an environment in which numbers are never free-standing but, rather, are always presumed to carry moral messages, and in which domains that cannot be quantified serve as a primary basis for knowing truth. Through an exploration of rural Tibetan encounters with health development programs for safe motherhood, I provide a critique of quantification and return to questions about “belief” as a rubric that interrupts modern dichotomies of lies versus truths.