In lieu of an abstract, here is a brief excerpt of the content:

Reviewed by:
  • Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic by Julie Livingston
  • Betsey Brada
Julie Livingston. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham, N.C.: Duke University Press, 2012. xvi + 228 pp. Ill. $84.95 (cloth, 978-0-8223-5327-0), $23.95 (paper, 978-0-8223-5342-3).

Cancer in Africa, along with the suffering and death it causes, has been overshadowed on the international stage in recent decades by infectious diseases, HIV/AIDS foremost among them. In Improvising Medicine Julie Livingston draws on sensitive and fine-grained ethnographic research conducted between 2006 and 2010 to offer a gripping portrait of a cancer epidemic that has unfolded just as Botswana’s government began making antiretroviral therapies (ARVs) freely available to its HIV-positive citizens. In a cruel irony, the advent of free ARV treatment has made it possible for Botswana’s citizens to survive HIV infection only to confront virus-associated cancers. Livingston’s study of Botswana’s only oncology ward draws critical attention to, first, the necessarily improvisational nature of oncology practice in contemporary Botswana and, second, the inextricably social experience of cancer, even when care fails. Even though, as she notes, neither of these dynamics is exclusive to Africa, attending to their specific manifestations in Botswana sheds light on the challenges that African health care systems and international institutions must confront as ARV treatment expands across the continent. “Cancer in Africa,” she insists, “is an epidemic that will profoundly shape the future of global health” (p. 7).

Although she bases her analysis on recent ethnographic data and situates the stakes of her argument squarely in the future, Livingston emphasizes the historical dimensions of her object of analysis, elegantly incorporating her earlier research. She offers “a history of the alternating invisibility and visibility of African cancers, asking what kinds of biological publics are envisioned in global public health, and what taxonomies of care and prevention ensue from this vision” (p. 31). The “conceptual impossibility” of cancer in Africa, she argues, “has rendered African publics particularly vulnerable to the carcinogenic fallout of global capital” (p. 33), including heightened risks due to malnutrition, subclinical infections, and the occupational and environmental hazards of mining and other industries that have historically placed African bodies disproportionately in danger. While “many of Botswana’s cancer patients suffer from virus-associated cancers that are facilitated by HIV-related immunosuppression” (p. 10), cancer in Botswana cannot be solely attributed to HIV. Instead, throughout the book Livingston balances accounts of how the HIV epidemic and the national ARV treatment program are shaping cancer in contemporary Botswana with careful attention to how the history of global capitalism, the priorities of colonial and postcolonial health services, and the narrow focus and vested interests of international health have shaped both the visibility of cancer in southern Africa and Africans’ experiences of suffering and care.

The book as a whole is extremely readable, rendering complex concepts in science studies and medical anthropology accessible to nonspecialists through exceptionally clear prose. This is achieved thanks in large part to Livingston’s eye for ethnographic detail, her attention to the singularity of individuals’ experiences, [End Page 218] and her appreciation of the multidimensionality of individuals themselves. Drawing readers’ attention to the high-stakes and complex ethical and moral dilemmas of oncology care, she is careful to keep individuals from converging into types. For example, nurses on the oncology ward show deep empathy for patients at some moments and utterly fail to respond to their needs in others, but Livingston does not allow these nurses to become caricatures of callousness and hypocrisy or of their opposites. Sensitive but not sentimental, Livingston’s writing is attuned to how the recognition of individual pain and collective suffering is granted to people differentially. Her attention to boredom, hilarity, revulsion, conflict, and hope lends much-needed nuance to accounts of pain and suffering in Africa, illuminating how Africans and non-Africans work under difficult circumstances and sometimes in contradictory ways to keep those who suffer socially connected and part of a living world.

Livingston does not shy away from the gruesome or painful, but she self-reflexively endeavors to avoid...

pdf

Share