This essay argues that what makes "global health" "global" has more to do with configurations of space and time, and the claims to expertise and moral stances these configurations make possible, than with the geographical distribution of medical experts or the universal, if also uneven, distribution of threats to health. Drawing on a study of public-private partnerships supporting Botswana's HIV/AIDS treatment program, this essay demonstrates ethnographically the processes by which "global health" and its quintessential spaces, namely "resource-limited" or "resource-poor settings," are constituted, reinforced, and contested in the context of medical education and medical practice in Botswana's largest hospital. Using Silverstein's work on orders of indexicality, I argue that the terms of "global health" are best understood as chronotopic, and demonstrate how actors orient themselves and others spatio-temporally, morally, and professionally by using or refuting those terms. I conclude by arguing that taking "global health" on its own terms obscures the powerful forces by which it becomes intelligible. At stake are the frames within which medical anthropologists understand their objects of study, as well as the potential for the spaces of "global health" intervention to expand ever outward as American medical personnel attempt to calibrate their experiences to their expectations.
Concerned that children understood the word AIDS to portend their imminent deaths, U.S. pediatricians in Botswana used ritual speech to reveal HIV‐positive children's diagnoses to them in an effort to ensure these children took their medications. They relied on euphemisms such as soldier and bad guy, gradually and methodically replacing them with biomedically derived terms. While the ritual was predicated on transparency and accuracy, pediatricians’ conviction that the word AIDS impaired children's ability to manage their infections led them to silence representations of the epidemic as anything other than a manageable condition in order to create a stable object of biomedical intervention.
One consequence of the recent expansion of anthropological interest in humanitarianism is the seeming obviousness and conceptual stability of "humanitarianism" itself. In this article, I argue that, rather than being a stable concept and easily recognizable phenomenon, humanitarianism only becomes apparent in relation to other categories. In short, humanitarianism is contingent: it depends on circumstance and varies from one context to another. Furthermore, its perceptibility rests on individuals' capacity to mobilize categorical similarities and distinctions. One cannot call a thing or person "humanitarian" without denying the humanitarian character of someone or something else. Drawing on research conducted in clinical spaces where Botswana's national HIV treatment program and private US institutions overlapped, I examine the processes by which individuals claimed people, spaces, and practices as humanitarian, the contrasts they drew to make these claims, and the moral positions they attempted to occupy in the process. More than questions of mere terminology, these processes of categorization and contradistinction serve as crucibles for the larger struggles over sovereignty, inequality, and the legacies of colonialism that haunt US-driven global health interventions. [humanitarianism, global health, expertise, semiotics, Botswana, HIV/AIDS] RÉSUMÉ Une des conséquences du récent progrès de l'intérêt des anthropologues pour l'humanitarisme est l'apparenteévidence et stabilité conceptuelle de «l'humanitarisme» lui-même. Dans cet article, je soutiens que l'humanitarisme n'est pas un concept stable et un phénomène aisément identifiable mais ne devient apparent que mis en relation avec d'autres catégories. En somme, l'humanitarisme est contingent: il dépend des circonstances et varie d'un contexte a l'autre. Par surcroît, sa perceptibilité repose sur la capacité des individusà faire valoir des similarités et distinctions catégorielles. Une personne ou un objet ne peuventêtre appelés «humanitaire» sans que ne soit nié le caractère humanitaire d'un autre objet ou personne. En me fondant sur des recherches menées dans des espaces cliniques où se chevauchent le programme national botswanais de traitement du VIH et les institutions privéesétasuniennes, j'examine les processus par lesquels les individus déclarent «humanitaires» des personnes, des espaces et des pratiques, les contrastes qu'ils constituent pour soutenir leurs déclarations et les positions morales qu'ils tentent ce faisant de prendre. Davantage que des questions simplement terminologiques, ces processus de catégorisations et d'oppositions servent de creuset aux luttes sur des questions de souveraineté, d'inégalité et d'héritages coloniaux qui hantent les interventions de santé globale définies par lesÉtats-Unis.[humanitarisme, santé mondial, compétence, sémiotique, Botswana, VIH/SIDA] RESUMEN Una consecuencia de la expansión reciente del interés antropológico en el humanitarismo es la aparente obviedad y estabilidad conceptual del "humanitarismo" en sí mismo...
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