Global Health, Malaria, and Child Survival in Tanzania
Publication Year: 2013
Malaria control, according to Kamat, has become increasingly medicalized, a trend that overemphasizes biomedical and pharmaceutical interventions while neglecting the social, political, and economic conditions he maintains are central to Africa’s malaria problem. Kamat offers recent findings on global health governance, neoliberal economic and health policies, and their impact on local communities.
Seeking to link wider social, economic, and political forces to local experiences of sickness and suffering, Kamat analyzes the lived experiences and practices of people most seriously affected by malaria—infants and children. The persistence of childhood malaria is a form of structural violence, he contends, and the resultant social suffering in poor communities is closely tied to social inequalities.
Silent Violence illustrates the evolving nature of local responses to the global discourse on malaria control. It advocates for the close study of disease treatment in poor communities as an integral component of global health funding. This ethnography combines a decade of fieldwork with critical review and a rare anthropological perspective on the limitations of the bureaucratic, technological, institutional, medical, and political practices that currently determine malaria interventions in Africa.
Published by: University of Arizona Press
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Title Page, Copyright, Dedication
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List of Illustrations
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Malaria is a complex mosquito-borne parasitic disease. It has an equally complex social history that is inextricably linked with poverty and struc-tural inequality. The book’s title “Silent Violence” is derived from Randall Packard’s The Making of a Tropical Disease (2007) in which he demon-strates how the history of malaria is closely tied to chronic poverty, which ...
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This book is a culmination of more than a decade of research and writ-ing on malaria in Tanzania. It is also a partial record of how Tanzania’s malaria program has unfolded over a decade, its pivotal moments, and the direction in which it is headed. In the summer of 1998, CARE Tanzania offered me my first opportunity to travel to Africa as a consultant on a ...
Part I: Global Discourses
1. The Violence of a Global Killer
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Epidemics are “mirrors held up to society,” revealing differences of ideol-ogy and power as well as special terrors that haunt different populations.We should think about health for health’s sake. Preventing hundreds of millions of malaria cases and deaths of millions of children should be rea-One early morning in February 2001, the head nurse at the village dispen-...
2. Locating the Field
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Official stories of structural adjustment tell of a better life for all Tanzani-ans found in The Free Market, and in a world of expanded and expanding horizons and opportunities that accompany it. This “opening up” is natu-ral, rational and so obviously amoral and desirable that it scarcely merits attention, let alone discussion. From the sidelines, ordinary Tanzanians tell a ...
3. Commanding Heights and Failed Promises
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Composed of two formerly independent entities, Tanganyika and Zanzi-bar, the United Republic of Tanzania is a state wracked by contradiction, fraught with multiple cleavages, and characterized by a condition of what Throughout much of Africa one also finds a widespread and profound sense of foreboding, a perceived crisis in the fundamental conditions of ...
Part II: Local Practices
4. Micropolitics of Childhood Malaria
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User fees are a common financing mechanism used to increase resources available to the health care system and to recover a portion of costs.One early afternoon in April 2001, on my way to Kimbangulile, a small hamlet that sits on the top of one of the hills surrounding Mbande village, I recognized Zaituni, a woman in her mid-forties, as she was coming down ...
5. Malaria Deaths and Meaning Making
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Infant deaths become routine in an environment in which deaths are antic-Mothers’ failure to obtain medical care for severely ill children is due more to real-life bureaucratic and geographic barriers to access than to fatalistic Mwanzani, a forty-four-year old woman was desperately trying to revive her dying two-year-old daughter, Salama. Mzee Tinyango, the local ...
6. Malaria, Single Mothers, and Social Suffering
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The melancholic nature of much theorizing in the social and human sci-ences is perfectly comprehensible because of the ethical commitment many practitioners have to “telling it like it is,” documenting and analyzing the horrors and miseries of the contemporary world, explaining how the privil-ege of some creates the misfortune of many, how power distorts and extracts ...
Part III: Philanthrocapitalism
7. Old Ideas and New Promises
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Over the past ten years or so there has been a precipitous decline in the efficacy of CQ [chloroquine] across Africa and, in our view, this is the most plausible single factor contributing to the change in malaria-specific The current discussions of malaria resurgence tend to place the disease in the active voice and thereby depict humans as passive victims. In the ...
8. Pharmaceutical Nexus and Globalizing Antimalarials
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When we analyze the global production and distribution of pharmaceuti-cals from an ethnographic standpoint, we find areas of practice that defy standardization. A variety of distinct niches—regulatory, medical, ethi-cal, legal, scientific, and economic—related to the anthropological study of pharmaceuticals take specific forms in local contexts and affect indi-...
Part IV: The Way Forward
9. Conclusion: From Malaria Control to Malaria Elimination
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The anthropological tactic of attempting to expose social suffering by bringing the local worlds to the attention of global audience runs the risk of legitimating social inequality if it fails to challenge the global preten-tions of elite accounts, to bring out the global critiques often found in the narratives of poor and racialized populations, and to confront the gate-...
10. Epilogue: The End of Malaria?
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On June 25, 2011, I visited Mbande along with three graduate students from North America and the U.K. who had read my work and wanted to see it for themselves. Prior to this visit, I had decided that this would be my last research-related visit to the village because I had initiated field-work on food security in the Mtwara region on the Tanzania-Mozambique ...
Glossary of Kiswahili Terms
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About the Author
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Vinay Kamat received his PhD in social work from the Tata Institute of Social Sciences in Bombay, India, in 1992 and his PhD in anthropology from Emory University in 2004. He had been an assistant professor of anthropology at the University of British Columbia since 2003 and in 2010 was promoted to associate professor. Since 1998, Kamat has per-...
Page Count: 320
Illustrations: 15 photos, 1 table, 2 maps
Publication Year: 2013