‘I could not be idle any longer’: buruli ulcer treatment assemblages in rural Ghana

Abstract

Buruli ulcer is a necrotizing skin infection that largely affects poor people in the tropics. In Ghana, federal policies promise free treatment to all individuals with the disease. Yet, this research found there is a tension between official policy narratives and the lived experiences of people in endemic regions. I demonstrate that as top-down government channels struggle to provide sick people with care, new treatment assemblages emerge in rural areas. I use the experiences of two individuals and one group of practitioners-the pirate, hybrid herbalist, and practitioners for profit-to detail the social relationships and practices governing Buruli ulcer treatment. These treatment assemblages reflect diverse knowledge and economic forms and represent lines of flight from official, and exclusionary, systems of disease surveillance. In contrast with existing literature on Buruli ulcer in Africa, I argue rural people's engagement with "traditional" medicine is often the result of policy failures and the disease is under-represented in national case counts. This work contributes to a growing body of critical political ecologies of health by examining the ways non-humans (e.g. Mycobacterium ulcerans, wild plants, antibiotics), policy, desire, and prosaic practices combine to shape disease and treatment dynamics.

Framing bovine tuberculosis: a ‘political ecology of health’ approach to circulation of knowledge(s) about animal disease control

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Unpacking Land Grabs: Subjects, Performances and the State in Ghana's ‘Small‐scale’ Gold Mining Sector

“…Ghanaian state actors are entangled in complex relationships and practices shaping foreign control of small‐scale concessions. Untangling these dynamics reveals the state not as a monolithic entity; rather, it is a constellation of diverse agencies and individuals rife with shifting, contradictory interests and performances (see also Hausermann, ; Ogden, ).…”

“…These sweeping characterizations fail to capture the incredible spatio‐temporal complexity of state–society dynamics. We argue there is nothing coherent or a priori about the state; rather, governments are made up of diverse, often contradictory, people and practices (Hausermann, ; Ogden, ; Secor, ). An understanding of ‘prosaic stateness’ reveals complex, subtle and uneven geographies of state power (Painter, : 755).…”

“…are entangled in complex relationships and practices shaping foreign control of small-scale concessions. Untangling these dynamics reveals the state not as a monolithic entity; rather, it is a constellation of diverse agencies and individuals rife with shifting, contradictory interests and performances (see also Hausermann, 2015;Ogden, 2011). Our understanding of the state thus diverges from scholars' ongoing characterizations of African governments as 'weak' states due to 'neopatrimonialism', bureaucratic 'inefficiency' and 'poor' delivery of services (Peters, 2004: 287;Reno, 1995: 112;Reno, 2001: 204).…”

Global health from the outside: The promise of place-based research

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