The Aftermath of Aid: Medical Insecurity in the Northern Somali Region of Ethiopia Item Type text; Electronic Dissertation Authors Carruth, Lauren Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 07/10/2021 02:01:50 Link to Item http://hdl.handle.net/10150/203474 THE AFTERMATH OF AID: MEDICAL INSECURITY IN THE NORTHERN SOMALI REGION OF ETHIOPIA by Lauren Carruth _____________________ A Dissertation Submitted to the Faculty of the SCHOOL OF ANTHROPOLOGY In Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY In the Graduate College THE UNIVERSITY OF ARIZONA 2011 2 THE UNIVERSITY OF ARIZONA GRADUATE COLLEGE As members of the Dissertation Committee, we certify that we have read the dissertation prepared by Lauren Carruth entitled "The Aftermath of Aid: Medical Insecurity in the Northern Somali Region of Ethiopia" and recommend that it be accepted as fulfilling the dissertation requirement for the Degree of Doctor of Philosophy _______________________________________________________________________ Date: 9/29/11 Mark Nichter _______________________________________________________________________ Date: 9/29/11 Ivy Pike _______________________________________________________________________ Date: 9/29/11 Laura Briggs _______________________________________________________________________ Date: Final approval and acceptance of this dissertation is contingent upon the candidate’s submission of the final copies of the dissertation to the Graduate College. I hereby certify that I have read this dissertation prepared under my direction and recommend that it be accepted as fulfilling the dissertation requirement. ________________________________________________ Date: 9/29/11 Dissertation Director: Mark Nichter 3 STATEMENT BY AUTHOR This dissertation has been submitted in partial fulfillment of requirements for an advanced degree at the University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations from this dissertation are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the author. SIGNED: Lauren Carruth 4 ACKNOWLEDGEMENTS Above all, I am indebted to the participants in this research; this ethnographic study is, at its best, a testament to your intelligence and tenacity. My husband and I are both grateful for the unwavering generosity and kindness we were shown during our stay in and around the Somali Region of Ethiopia. To Farah Mussa and Nimo Ahmed: this project would not have been possible without your wisdom, guidance, and humor. To Brook Tadesse, Melkam Araya, and James Krueger: thanks for your friendship and laughter over many plates of injera. To my committee, Mark Nichter, Ivy Pike, and Laura Briggs: thanks for your careful reading and remarkable engagement with these stories. I could not have asked for a more dedicated set of advisors. Additionally, Mark Nichter’s enthusiasm for this project–from fieldwork to writing–was both vital and invigorating. As I wrote, Micah Boyer, Sarah Trainer, and Jennifer Jo Thompson provided kind and copious moral and editorial support. I could not have completed this research without institutional and logistical support from UNICEF Ethiopia, including Bukhari Sheikh Aden and Bjorn Ljundqvist among others; the Feinstein International Center at Tufts University and their office staff in Addis Ababa; and faculty in the Department of Social Anthropology at Addis Ababa University. Several policymakers at the Somali Regional Health Bureau, including most prominently Meftuh Ismail, were incredibly insightful about the challenges they faced trying to improve health care for Somalis in Ethiopia; I hope to be a part of their efforts in the future. I’m also grateful to Jane Hultberg and Trisha Cantwell- Keene at the College of the Atlantic, who provided a supportive environment to write. For the generous funding that made this research possible, my thanks are extended to the Wenner-Gren Foundation for Anthropological Research, the National Science Foundation, and the Social & Behavioral Sciences Research Institute and School of Anthropology at The University of Arizona. Many of my theoretical insights stemmed from thoughtful conversations at the Pembroke Center for Research and Teaching on Women at Brown University with Kay Warren, Bianca Dahl, Sherine Hamdy, and others. Also, this research tackles the significance of healing, as distinct from biomedical care, and the importance of trusted clinical encounters to this end. My insights in this regard owe immensely to time I spent with Cheryl Ritenbaugh and other faculty in the College of Medicine at The University of Arizona who sought to understand and facilitate healing within the parameters of the strained public health and medical education systems in Tucson. On more personal notes, a tremendous debt of gratitude goes to my two mothers, Deb Carruth and Phyllis Machledt, for caring for sweet Winslow during my long summer of writing. Thanks to Deb Carruth for your sharp editorial eyes as well. Finally, my appreciation goes to David Machledt, for diving into life in the Somali Region with such pleasure and energy. I could never have completed this project without our long walks, your ingenuity, or your steadfast love and support. 5 DEDICATION To my father, Bruce Carruth, for instilling in me curiosity about the lives of others and a sense of adventure. 6 TABLE OF CONTENTS LIST OF FIGURES .............................................................................................................9 LIST OF TABLES.............................................................................................................10 GUIDE TO SOMALI LANGUAGE PRONUNCIATION ...............................................11 ABSTRACT.......................................................................................................................12 INTRODUCTION .............................................................................................................14 Research Questions and Ethnographic Situation ...........................................................19 Paradoxes of Humanitarianism......................................................................................24 Summary of Methods and Methodology .......................................................................27 Summaries of Chapters..................................................................................................30 CHAPTER 1. ETHNOGRAPHIC SETTING...................................................................40 Setting the Stage ............................................................................................................40 Livelihoods and Basic Demographic Information.........................................................49 Community Field Sites ..................................................................................................59 Aysha town.................................................................................................................60 Degago.......................................................................................................................63 Elahelay .....................................................................................................................65 Histories of Somalis in the Horn of Africa ....................................................................67 Post-colonial Histories of Northern Somalis .................................................................73 Flows of Medicine: Medicine and Healthcare Supply Systems ....................................93 Public health providers and public facilities.............................................................93 Extra-legal economies of medications.......................................................................97 Medical humanitarian relief operations ....................................................................98 Summary......................................................................................................................102 CHAPTER 2. METHODOLOGY, RESEARCH METHODS AND DESCRIPTION OF THE SAMPLE................................................................................104 Methodology................................................................................................................104 Summary of Methods and Data Sources......................................................................108 Phases of Field Research .............................................................................................112 Phase I. Exploratory Research ................................................................................112 Phase II. Institutional and Clinical Ethnography....................................................115 Phase III. Community-Based Ethnography .............................................................122 Analysis of Data...........................................................................................................135 My Position as a Researcher........................................................................................136