Silent Violence: Global Health, Malaria, and Child Survival in Tanzania

Preface

xi Preface Malaria is a complex mosquito-borne parasitic disease. It has an equally complex social history that is inextricably linked with poverty and structural inequality. The book’s title “Silent Violence” is derived from Randall Packard’s The Making of a Tropical Disease (2007) in which he demonstrates how the history of malaria is closely tied to chronic poverty, which manifests itself in violence that is often silent. In 2000, when I started my fieldwork in Tanzania, it was believed that malaria affected between 300 and 500 million people worldwide and killed more than 3 million people, 90 percent of them children, mostly in sub-Saharan Africa, each year. More than a decade later, in its 2012 Malaria Report, the World Health Organization noted that between 2000 and 2010, the global malariaspecific mortality rates fell by 26 percent. This is encouraging news. However , the rates of decline are far lower than internationally agreed targets for 2010, which called for reductions of 50 percent. Malaria continues to kill hundreds of thousands of young children, mainly in Africa, each year. In this book I argue that global efforts to deal with malaria have achieved limited success because malaria is increasingly being cast as a bureaucratic, managerial problem and the core of the problem systematically depoliticized. As such, I illustrate how the persistence of malaria in Tanzania and elsewhere in Africa can be better explained from an anthropological perspective by framing it within a critique of neoliberal global discourses on malaria control and elimination. I explore the persistence of childhood malaria in Tanzania as a form of structural violence that emanates from historically situated structured inequality, and the xii · Preface resultant human suffering. I illuminate the processes that are closely tied to structural inequalities and hegemonic global discourses on malaria that are increasingly becoming biomedicine-based, technological fixes. Case studies and illness narratives in the various chapters highlight not just the social burden of malaria, but the salience of the diversity of experiences within a specific sociocultural context. My goal is to bring people’s lived experience with malaria, and the local context in which malaria-related social suffering is embedded, to the attention of a global audience of both readers and policy makers. I wish to demonstrate how “top down” policies and interventions are locally and individually experienced. Each chapter is grounded in ethnographic data focusing on a particular theme that is closely tied to the larger goal of illustrating how globally determined policies on malaria are locally experienced in Tanzania. I have included numerous ethnographically rich case studies and narratives in the different chapters. I have tried to write in a style that is easy to follow, and uncluttered by anthropological jargon. Most important, Silent Violence provides a theoretical argument linking the persistence of malaria in sub-Saharan Africa, particularly in Tanzania, with the politics of global health governance, as well as the “pharmaceutical nexus,” driving the global antimalarials market. Silent Violence fills a gap in the anthropological literature on infectious disease—the lack of a detailed book-length ethnographic study on childhood malaria. The anthropological literature on malaria is growing. However, a detailed ethnographic study on malaria that traces the cultural meanings and human experiences of the illness has been missing. Silent Violence adds to the growing effort within anthropology in general and critical medical anthropology in particular to examine and explain the reemergence and persistence of “global killers”—infectious disease such as HIV/AIDS, tuberculosis, malaria, and cholera in relation to the larger, global political economic systems and institutional structures that perpetuate and intensify social inequalities. This book demonstrates that an anthropological account of malaria in Tanzania is at the heart of current theoretical and policy debates concerning the impact of globalization and neoliberal economic policies on local communities. It demonstrates the manner in which the implementation of neoliberal economic reforms has diminished the state’s responsibility to provide health care to its citizens, making health an individual’s responsibility rather than an individual’s basic right. Over the course of the last decade I have often been asked by friends, colleagues, students, and the people I interview and engage in conversation in Tanzania to learn about malaria: Will malaria be eradicated Preface · xiii anytime soon with all the technology and unprecedented funding that we have at our disposal today? Why don’t we have a vaccine for malaria yet? Why are so many children still...