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Malarial Proximities: Senegal, the Pursuit of Evidence, and the Silver Revolver Approach to Global Health by Marlee Jo Tichenor

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Malarial Proximities: Senegal, the Pursuit of Evidence, and the Silver Revolver Approach to Global Health by Marlee Jo Tichenor Malarial Proximities: Senegal, the Pursuit of Evidence, and the Silver Revolver Approach to Global Health by Marlee Jo Tichenor A dissertation submitted in partial satisfaction of the requirements for the degree of Joint Doctor of Philosophy with University of California, San Francisco in Medical Anthropology in the Graduate Division of the University of California, Berkeley Committee in charge: Professor Cori Hayden, Chair Professor Vincanne Adams Professor Charis Thompson Professor Abena Dove Osseo-Asare Summer 2016 Malarial Proximities: Senegal, the Pursuit of Evidence, and the Silver Revolver Approach to Global Health ©Marlee Tichenor, 2016 1 Abstract Malarial Proximities: Senegal, the Pursuit of Evidence, and the Silver Revolver Approach to Global Health By Marlee Jo Tichenor Joint Doctor of Philosophy with University of California, San Francisco in Medical Anthropology University of California, Berkeley Professor Cori Hayden, Chair Through the lens of malaria control and eradication efforts, this dissertation considers the political nature of demarcating global health problems and the pursuit of evidence to support such framings. By attending to past international campaigns to eliminate malaria and shifts in the goals of international health as a whole, I investigate what is new about what some have called the “silver revolver” approach to global health governance: the deployment of simple, technologically-innovative tools to attack a disease from multiple angles through the support of public-private partnerships. Based on fieldwork with health workers, biologists, public health officials, and recipients of care in and around Dakar, Senegal and with designers and funders of malaria interventions in California, Switzerland, and Italy, my dissertation shows what counts as knowledge and who frames possible futures in global health research, design, implementation, and evaluation. I argue that talking about malaria means getting close to malaria or speaking from the proximity of malaria, as the ecologies that malaria produces and that produce malaria vary greatly on the parasite’s and its hosts’ historical, political, and socio-economic contexts. Speaking of malaria on a global scale – in a project of global control or global eradication – means creating and maintaining conceptual proximities through the discourse of a single, unified “malaria” (Kelly and Beisel 2012). Examining the central role of the informal in malaria treatment, practices of approximation in malaria diagnosis, and the space for political resistance in health data collection in Senegal, I argue that attention to conflicts over malarial knowledge and practices is in fact crucial to dreams of malaria eradication, as well as to a “more democratic and equitable” global health (Geissler 2011). i TABLE OF CONTENTS MALARIAL PROXIMITIES: Senegal, the Pursuit of Evidence, and the Silver Revolver Approach to Global Health ACKNOWLEDGEMENTS ..................................................................................................................... III ABBREVIATIONS ................................................................................................................................... IV CHAPTER ONE: INTRODUCTION ....................................................................................................... 1 AN EVENT ................................................................................................................................................. 1 MALARIAL DREAMS .................................................................................................................................. 2 MAPPING ACTORS, CRAFTING HISTORIES, DELINEATING ECOLOGIES .................................................... 4 THE RE-EMERGENCE OF MALARIA CONTROL AND ERADICATION DREAMS ............................................ 7 ON GLOBAL ASSEMBLAGES ...................................................................................................................... 9 MALARIAL PROXIMITIES ......................................................................................................................... 10 PROXIMITIES’ THEORETICAL RELATIONS ............................................................................................... 11 HUMANITARIAN BIOMEDICINE AND ECONOMIC MODELS ...................................................................... 12 THE PURSUIT OF EVIDENCE: CONTEMPORARY GLOBAL HEALTH AND CRITICAL SCIENCE STUDIES .... 13 GLOBAL MALARIA, GLOBAL SENEGAL .................................................................................................. 17 LABOR, INFRASTRUCTURE, AND IMAGINED FUTURES ............................................................................ 18 METHODOLOGY ...................................................................................................................................... 19 ORGANIZATION OF THE DISSERTATION .................................................................................................. 20 INTERLUDE: SITUATING THE ANTHROPOLOGIST ................................................................... 22 CHAPTER TWO: TREATMENT .......................................................................................................... 25 PRODUCING LEGITIMACY, ASSERTING CAUSATION ............................................................................... 27 INFORMALITY AND THE MARGINS .......................................................................................................... 27 SIMPLE TOOLS AND A NARRATIVE OF ERADICATION DREAMS .............................................................. 30 IL AIME L’INFORMEL: GUÉDIAWAYE, ARTEMISIA TEA, AND THE SEARCH FOR LEGITIMACY ................. 34 CONCLUSION: PARALLEL STORIES, DEAD ENDS, AND POSTCOLONIAL ENTANGLEMENTS ................... 36 CHAPTER THREE: MARKETS ............................................................................................................ 39 A HISTORY OF ARTEMISININIC DISCOVERIES ......................................................................................... 39 HUMANITARIAN BIOMEDICINE AND THE SCIENTIFIC IMPERATIVE TO DO GOOD .................................. 42 SYNTHETIC ETHICS: THE ARTEMISININ PROJECT STORY ....................................................................... 46 BIOLOGICAL PATHWAYS AND DISTINGUISHING ARTEMISI(A)(NIN)S ..................................................... 49 MAKING A MARKET: GLOBAL HEALTH SCIENCE AND REPRESENTING THE GLOBAL SOUTH ................ 53 CONCLUSION: MAINTENANCE VERSUS INNOVATION ............................................................................. 54 CHAPTER FOUR: DIAGNOSIS ............................................................................................................ 55 MALARIA AS MICROBIOLOGICAL AGENT ............................................................................................... 58 MALARIA AND THE SENEGALESE PUBLIC HEALTH SYSTEM .................................................................. 61 IN SEARCH OF PLASMODIA ..................................................................................................................... 64 DEFINING MALARIA IN THE LAB ............................................................................................................. 66 JËL NGA SA WÀLL: HAVE YOU HAD YOUR MALARIA YET? ....................................................................... 68 CONCLUSION: APPROXIMATION THROUGH PRECISION .......................................................................... 70 CHAPTER FIVE: DATA ......................................................................................................................... 71 THE NMCP PHARMACEUTICAL EVALUATION AND SURVEY TEAM GOES TO THE FIELD ...................... 73 DATA PERFORMATIVITY AND MALARIAL PROXIMITIES ......................................................................... 76 ii THE 2010-2013 HEALTH WORKER DATA RETENTION STRIKE ............................................................... 78 HISTORY OF THE DATA RETENTION STRIKE ........................................................................................... 82 DATA MANAGEMENT, AND EVERYTHING ELSE ..................................................................................... 83 CONCLUSION: DATA AND LABOR ........................................................................................................... 85 CONCLUSION .......................................................................................................................................... 86 CHASING ANOPHELES AND THE NEXT SILVER BULLET: GENETICALLY MODIFIED MOSQUITOES ......... 87 BIBLIOGRAPHY ..................................................................................................................................... 89 iii ACKNOWLEDGEMENTS This dissertation is the product of countless fruitful friendships and mentoring relationships, of conversations in offices, on public transportation, over Skype, and many other spaces in different parts of the globe. Naming all of these mentors and friends will be an incomplete exercise here, as some I have kept anonymous in these pages and cannot properly thank them here. Academically, I have been blessed with a committee full of brilliant scholars and amazing human beings. I would like to thank Cori Hayden, my dissertation chair, for her unflagging support and guidance, for constantly pushing my work further, and for being such an incredible academic role model. I thank Vincanne Adams
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