Technologies of care and the engineering imaginary: Two approaches to assistive device design for the Global South

Assistive devices serve as vectors for the ideals, judgments, and goals that their society of origin has towards people with disabilities. For some Ugandan inventors and prosthetists, familiarity with sociocultural norms and consistent feedback allow them to design prosthetic limbs as technologies of care that specifically meet the needs of Ugandans using these devices. In contrast, many biomedical engineers living in the United States rely on what I call the "engineering imaginary" to produce universalized forms of assistive technology intended for people living in an essentialized Global South. Drawing on research with engineers, prosthetists, and people living with limb loss in Uganda and the United States, I investigate the social and cultural aspects of prosthetic limb design and argue that there is a cross-cultural mismatch about what a prosthetic device does and what kinds of limbs it should fit. This mismatch becomes inscribed in the prosthetic device itself.

Violence at Rikers Island: Does the Doctor Make It Worse? A Clinician Ethnographer's Work Amidst Carceral Structural Violence

In this article, I describe the dilemmas of working as a physician-ethnographer within the Rikers Island jail healthcare system before and at the beginning of the COVID-19 epidemic in April 2020. The Rikers Island jail system in New York City has been in the national spotlight as a space of violence, trauma, and death amidst calls to decarcerate by community members and abolition advocates. This article is a personal reflection on the labor and subjectivity of healthcare providers and their positionality to multiple axes of structural and interpersonal violence while attempting to provide care in carceral institutions. I observe how COVID-19 functioned as an additional form of structural violence for incarcerated people. Clinical ethnography remains an essential tool for understanding complex social phenomena such as violence. However, physician-ethnographers working in these spaces of structural violence can have unique and conflicting constraints: tasked with providing evidence-based medicine but also simultaneously participating in an unusual form of labor that is an amalgamation of care, social suffering, and punishment. Despite and across at-times conflicting roles and obligations, I propose that these fragmented subjectivities can foment social criticism, propel advocacy toward decarceration, and produce a critically engaged dialogue between fields of anthropology and medicine toward a goal of health justice.

Epidemic confusions: On irony and decolonisation in global health

The movement to decolonise global health is gathering pace. In its concern with the fundamental, distal causes of inequality and its call for social justice, the decolonisation movement forces us to question how global health works, for whom, where it is located, its funding practices, power asymmetries, cultures of collaboration and publication. This paper uses a new book by Harvard-based physician-anthropologist Eugene T. Richardson, Epidemic Illusions, as a point of departure for a broader analysis of the nature of global health knowledge, science, authorship, research and practice. Written in a 'carnivalesque' style, the book proceeds through a series of 'ironic (re)descriptions' to argue that global public health is an 'apparatus of coloniality'. In so doing, the book is generative of four ironic turns that we explore through the themes of guilt, humility, privilege and ambiguity. In locating these ironic turns within the broader landscape of global health, we reflect on whether the means of such a book achieve the ends of decolonisation.