Comparative ethnographies of medical research: materiality, social relations, citizenship and hope in Tanzania and Sierra Leone

Abstract

In this paper we bring together ethnographic research carried out during two clinical prevention trials to explore identities, relations and political imaginations that were brought to life by these different technologies. We highlight the ways in which critical anthropological engagement in clinical trials can help us radically reconsider the parameters and standards of medical research. In the paper we analyse the very different circumstances that made these two trials possible, highlighting the different temporalities and politics of HIV and Ebola as epidemics. We then describe four themes revealed by ethnographic research with participants and their communities but mediated by the specific sociopolitical contexts in which the trials were taking place. In both countries we found materiality and notions of exchange to be important to participants’ understanding of the value of medical research and their role within it. These dynamics were governed through social relations and moral economies that also underpinned challenges to Western notions of research ethics. The clinical trials offered a language to express both disaffection and disillusionment with the political status quo (often through rumours and anxieties) while at the same time setting the foundations for alternative visions of citizenship. Attached to these were expressions of ‘uncertainty and hope’ steeped in locally distinctive notions of destiny and expectations of the future.

Spotlight on global health research

“…Lees and Enria's comparative ethnographies of preventive clinical trials conducted in Sierra Leone and Tanzania highlight the contributions of critical anthropological engagement in research, taking into account global and local power dynamics and demonstrating the true value of anthropology in clinical trials. 11 Finally, Henderson et al 12 point out that observational studies are also worthy of qualitative enquiry, outlining the bioethical nuances of a cohort study in Thailand.…”

Negotiating the Role of Anthropological Evidence in Medical Research during Health Emergencies

“…The social science protocol was separate from the trial, assuring scientific independence. Over the course of this first year, and the transition from epidemic to recovery, we produced an analysis on a range of issues including understanding how local conceptions of power, fairness and trust shaped initial engagements with the trial during the emergency; factors influencing decisions to take the Ebola vaccine; the articulation of citizenship aspirations through encounters with biomedicine; and the role of materiality, social relations and hope in defining everyday interactions with the trial as it became embedded in Kambia (Enria et al 2016;Enria and Lees 2018;Lees and Enria 2020;Tengbeh et al 2018). Alongside academic outputs, or hidden beneath them, were the everyday negotiations involved in communicating ethnographic evidence for the running of the trial.…”

Contesting the crisis narrative: epidemic accounts in Sierra Leone, Tanzania, and Democratic Republic of the Congo

“…Magufuli's rejection of foreign expertise was accepted alongside an ongoing distrust in foreign involvement in medical research. Previous anthropological research in HIV trials exposed narratives circulating within communities surrounding the research sites, that foreigners had nefarious intentions to harm Tanzanians (Lees and Enria, 2020). Ideas that the HIV virus or 'white man's' sperm was injected into HIV prevention technologies dominated.…”

“…Whilst response to the HIV epidemic in Tanzania was mostly addressed by international and national non-governmental actors at its emergence, high level government involvement was immediate in the suspected Ebola outbreak and the rapidly emergent COVID-19 pandemic. In local narratives in Tanzania, many citizens initially supported the president's stance against foreign involvement, possibly due to a longer history of HIV medical research and response (Lees and Enria, 2020). This contrasted with a more critical approach to the DRC government who were accused of 'copying and pasting' foreign public health measure for political gain.…”