Improvising Medicine: An African Oncology Ward in an by Julie Livingston

By Julie Livingston

In Improvising Medicine, Julie Livingston tells the tale of Botswana's simply devoted melanoma ward, situated in its capital urban of Gaborone. This affecting ethnography follows sufferers, their relations, and ward employees as a melanoma epidemic emerged in Botswana. The epidemic is a part of an ongoing surge in cancers around the international south; the tales of Botswana's oncology ward dramatize the human stakes and highbrow and institutional demanding situations of an endemic that may form the way forward for international future health.

They show the contingencies of high-tech medication in a medical institution the place very important machines are usually damaged, medications cross out and in of inventory, and bed-space is often at a top class. additionally they show melanoma as anything that occurs between humans. severe affliction, care, ache, disfigurement, or even demise turn out to be deeply social reviews. Livingston describes the melanoma ward by way of the paperwork, vulnerability, energy, biomedical technology, mortality, and desire that form modern event in southern Africa. Her ethnography is a profound mirrored image at the social orchestration of wish and futility in an African clinic, the politics and economics of healthcare in Africa, and palliation and disfigurement around the international south.

Julie Livingston is affiliate Professor of heritage at Rutgers college. She is the writer of Debility and the ethical mind's eye in Botswana and a coeditor of 3 photographs at Prevention: The HPV Vaccine and the Politics of Medicine's uncomplicated suggestions and A dying Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of clinical Citizenship.

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But this does not mean that I did 24  Chapter One not participate—only that my participation was shaped by my abilities and limitations. I shadowed the hospital’s doctors, the nurses, and nursing assistants as they performed their daily tasks. While staff in pmh oncology worked hard, the volume of patients created significant labor pressures, and it quickly became impossible to merely sit by and observe. I often accompanied patients to radiology or to consultations with specialists in other parts of the hospital, acting as a combined porter and liaison—helping to clarify why Dr.

Oncology is predicated on a temporal urgency. As any patient (not only in Botswana) will tell you, a cancer diagnosis hurls one into a therapeutic pipeline at great speed. Dr. P recognizes that cancer patients cannot wait to be seen, without serious consequences. At pmh he is committed to seeing all the cancer patients who require attention on the day they arrive, rather than booking appointments with waiting times of weeks or even months for the newly diagnosed. He could send the patients away and ration his time so that his workload would be reasonable, perhaps fifteen patients a day.

Despite many new agents becoming available, often at great cost, the gains in terms of cure rates have been small. Fashion for high dose chemotherapy with bone marrow transplantation, the use of marrow support factors, biological therapies such as monoclonal antibodies or cytokines, have resulted in little overall gain but considerable expense. The driving force for medical oncology comes from the USA, which spends 60% of the world’s cancer drug budget but has only 4% of its population [the bulk of the remaining cancer drug budget is accounted for by Japan and Europe].

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