Research is our resource: Surviving experiments and politics at an African cancer institute, 1950 to the present

摘要

This dissertation is a historical-ethnography of the Uganda Cancer Institute. In the 1960s, the Institute was a small chemotherapy clinical trial facility established through a joint partnership between Ugandans and Americans. Today it is the only site of public oncology goods in the Great Lakes region of Africa. 60 beds serve a catchment of 40 million people. New research partnerships to examine HIV and cancer aim to transform this site from a dilapidated research enclave into a "center of excellence". To understand this transformation, I place African health workers and physician-researchers at the center of this story, and examine their political and medical labor in maintaining an African cancer hospital, decades after initial outside support evaporated. I do this by tracing the ways in which cancer research and care continued throughout several periods of profound transformation---independence (1960s), Idi Amin's dictatorship (1970s), civil war (early 1980s), structural adjustment (1980s-1990s), and the HIV epidemic (1980s to now). I argue that throughout these crises, Ugandan physician-researchers creatively secured equipment and drugs to maintain oncology services by making the case that "research is our resource" to the Ugandan government and international scientific community. The dissertation makes three key contributions. Firstly, I expand our understanding of medical knowledge production in postcolonial Africa. Historians, anthropologists, and sociologists have focused on the scramble for African research subjects and the questionable ethics of extraction from and experimentation on African bodies. Research is Our Resource works to move beyond this framing by examining not just the work of western scientists, but the equally critical work of Ugandan practitioners to create medical knowledge. Secondly, by integrating theory on technology transfer, infrastructure, and socio-technical systems with new approaches in the study of biomedicine as a cluster of technologies, I unpack the long-term repercussions of the transfer of oncology research and care to one corner of the Global South. I use this site of postcolonial knowledge production as a lens to examine how people cope with malignancies and malignant politics. The dissertation is based on over two years of archival and ethnographic research in Uganda, between 2009 and 2015.