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3 chapter one The Violence of a Global Killer Epidemics are “mirrors held up to society,” revealing differences of ideology and power as well as special terrors that haunt different populations. charles briggs and clara mantini-briggs 2003:8 We should think about health for health’s sake. Preventing hundreds of millions of malaria cases and deaths of millions of children should be reason enough to do whatever we can to fight this disease. randall packard 2009:80 One early morning in February 2001, the head nurse at the village dispensary and a young woman with a very sick child tied around her waist with a kanga, were engaged in a loud verbal battle on the dispensary’s verandah. They were calling each other names and making insulting references to each other’s kabila or ethnic identity. The yelling and gesturing match continued for about ten minutes. My limited communicative competence in Kiswahili1 and familiarity with the local cultural context at the time, led me to believe that the quarrel was over the young mother’s frustration with the poor quality of service offered at the dispensary, and the nurse in turn was blaming the mother for having delayed in bringing her sick child to the dispensary. The nurse, who I shall call Neema, and the young mother, Fatuma, abruptly ended their verbal match, smiled at each other, and shook hands. A dozen or so women who were at the dispensary with their sick children witnessed the drama and simultaneously burst into laughter. Nurse Neema now turned her attention to Fatuma’s child. Perplexed by the whole event, I asked Mzee Ali, my research assistant in the village,2 who was seated next to me, to explain to me what had just transpired at the dispensary. Nurse Neema and Fatuma were not really quarreling with each other, he told me; they were in fact having a bit of fun. Nurse Neema was a Chagga and Fatuma a Mzigua; they shared a utani/watani relationship—a ritualized joking relationship (see 3 4 · Global Discourses Beidelman 1986; Radcliffe-Brown 1940).3 On that day they were enacting their customary joking relationship at the dispensary to demonstrate their familiarity with each other, and perhaps more important, to alleviate the nervous tension and frustration that mothers experience as they wait patiently—some for up to six hours—for the dispensary staff to attend to their sick children. Fatuma’s nine-month-old daughter, Mariamu, was presumptively diagnosed (i.e., without a blood test) with malaria, a lifethreatening mosquito-borne infectious disease,4 and prescribed five injections of chloroquine over five days.5 Three weeks after this event occurred, I saw Fatuma again at the dispensary with Mariamu to deal with yet another fever episode. The routine was repeated; Mariamu was presumptively diagnosed with malaria and prescribed five more injections of chloroquine. It was the straw that broke Fatuma’s patience. She broke down in front of nurse Neema saying “nimechoka, nimechoka, nimechoka,” meaning that she was fed up with having to deal with her child’s sickness, and tired that her daughter was being prescribed the same medicine—chloroquine. Later that day, I learned from Fatuma that she was a twenty-three-year-old single mother of two young children. She did not have the resources to take her child to a private clinic or the district hospital, which was located fifteen miles away from the village. Therefore, she had no choice but to keep coming back to the village dispensary to deal with her daughter’s sickness, even if it meant that she would get the same diagnosis (malaria) and the same “useless” medicine (chloroquine). Fatuma’s case is hardly unique. I followed developments in her life for nearly a decade.6 Her life story is emblematic of what life is like for many poor mothers in rural Tanzania, especially those who are single or previously married and have to deal with their children’s sickness, which includes recurring bouts of malarial fevers and malaria-related complications (see also Muela Ribera and Hausmann-Muela 2011).7 I was made painfully aware of this on numerous occasions during interviews and in everyday conversations, when mothers would intersperse their narratives and conversations with the stock phrase “maisha magumu—tunahangaika tu!” (“Life is hard, we are just struggling!”). Embedded in the above vignette are elements of this book’s driving questions: How do shifting global discourses on malaria control affect the everyday lives and practices of...

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