An archaeology of medical science in twenty-first-century Africa
Paul Wenzel Geissler, Guillaume Lachenal, John Manton, and Noémi Tousignant, eds.
— Reviewed by
Paul Wenzel Geissler, Guillaume Lachenal, John Manton, and Noémi Tousignant, eds., Traces of the Future: An Archaeology of Medical Science in Twenty-First-Century Africa. Chicago: University of Chicago Press, 2016. Hardcover, 256 pages, 500 color plates, $28.50. ISBN: 9781783207251.
In recent years, scholars have started to assess the transformation of the American socioeconomic landscape brought about by globalization and deindustrialization. Some, like Dora Apel (2015), have sought to analyze the dying manufacturing cities of America’s industrial heartland, with its rusted factories and crumbling infrastructures ‘scattered like tombstones across the landscape of our nation’, to quote the dramatic metaphor of the forty-fifth president of the United States Donald Trump. However, such imagery is not peculiar to the United States. These modern ruins (or ruins of modernity) are becoming landmarks of a world increasingly marked by ‘capitalism’s fast-moving frontiers and built-in obsolescence, as well as political hubris and social conflicts’, in the words of anthropologist Shannon Dawdy (2010, 771). These are the traces of dying epochs and of the brutal and unharnessed march of hypercapitalism and hypermodernity.
Traces of the Future is a path-breaking, inspirational, and refreshing book that offers a close look at such vestiges of capitalism, modernity, and national and imperial ambitions. In this case, the book focuses not on the West’s decaying landscapes but those of postcolonial Africa. The book is superbly written – at times even poetic – and includes a preface by Nancy Rose Hunt. Additionally, its curatorial layout is striking. The text is ‘sutured’ (to borrow Hunt’s apt term) with photographs and archival material amassed from various sites. The arresting layout leaves the reader wondering if this is not a catalogue of a thought-provoking exhibition (past, present, or future) on scientific and biomedical ruins in Africa.
The book is organized around medical debris and remains at five key sites. The authors use the names of each site as their frame of analysis, instead of the kind of biomedical ruins found there, as these landmarks of African biomedical research have endlessly mutated. Uzuakoli in southeast Nigeria was originally a center of evangelical missionary work and a leper colony. The original ‘Uzuakoli Leprosy Center’ is today a dilapidated and dysfunctional estate occasionally used as a referral center for leprosy and tuberculosis. Ayos in Cameroon was once a sleeping sickness camp called ‘Ajoshöhe’ (German for ‘Ayos’, an onomatopoeic term for the sound of circumcision scissors). It is today a hospital and a school of nursing. Amani (a name given by German missionaries meaning ‘peace’ in the vernacular language) was a botanical institute in Tanzania that later morphed into a malaria unit and is today a medical research center. Niakhar in Senegal refers to a study initiated by the Senegalese government to improve civil registration in the Niakhar district. While this government initiative remains a ‘study zone’ today, it has mutated into a health and demographic surveillance system. Finally, Kisumu in Western Kenya, a sleeping sickness research hospital at the turn of the twentieth century, has recently become a global, albeit amnesiac, health city triggered by the AIDS epidemic.
Appealing to an audience interested in visual, material, archival, and ethnographic approaches, the book brings many disciplinary voices to bear on the fate and afterlife of colonial and postcolonial institutions of knowledge production and social engineering that litter the African landscape. The product is an exercise in a new kind of historico-anthropological work: an engagement with traces, debris, and remains as materials that reflect disorder, disarrangement, and shifting landscapes and paradigms. Like archeologists, the authors make sure to contextualize the artifacts. Each site is located in time and space; its traces ordered within chronological, topographical, and even linguistic grids; its biography laid out and its protagonists identified. The result is layers of reflections on the mutations of these sites.
The exhumed traces are unsettling because they reflect a crisis – both local and global – of discontinuity in the linear temporality of progressive and modernist (bio)political projects. This assemblage of traces also provides an opportunity to unveil the politics of precarious lives and a critique of the prescriptive and top-down neoliberal politics of the global health paradigm. The authors are engaged social scientists, and the spirit of their engagement permeates the text at every layer of their various and often collaborative excavations. They decry global health’s ‘vertical’ and ‘arrogant’ programs, which manifest as ‘bulldozers clearing rubble for new projects, as empty, brand-new buildings that appeared as ruinous as the derelict infrastructure they replaced’ (p. 24). The nostalgia that transpires is, however, not so much abjection as it is derision of global health billionaires ‘who parachute their free gifts, cheap hopes and platitudes across the continent’ (p. 25).
These vertical prescriptions, the authors argue, are part of a new ‘dispositif’ (in Foucauldian parlance) that destroys as it builds, erasing without leaving a memory or an assessment of past projects. The traces are also a reflection of aborted dreams and visions of the future. This is precisely why the authors, drawing on Paul Ricoeur, envision the traces not only as remains of a lost past but also as lineages of ‘living potentialities’ and thus as ‘traces of the future’.
The authors convincingly argue that these sites are not to be understood as ‘lieux de mémoire’, a concept introduced by the French historian Pierre Nora in the late 1970s (for more, see Nora 1989). Rather than glorifying and strengthening national narratives, these African postcolonial sites end up subverting the whole process of remembering and commemorating. They lay bare past power relations, past violations, and a politics of life or ‘biopolitics’, which as Michel Foucault (2004 [1978–1979]) defined it, amounts to the rationalities, strategies, techniques, and technologies deployed in the management of individuals and populations.
The authors are right to seek in these traces a reflection of common past trajectories and a glimpse of possible or imagined common futures. After all, this is not specific to Africa but to the growing divide between the wealthy and the poor, between those who profit from globalization and its losers, between those who hold the reins of and profit from neoliberal regimes and the rest of humanity.
There remains room for refining the critique of global health by deconstructing its monolithic and neocolonial carapace. The argument, though profound and timely, seems to reduce the advocates of global health into a singular bogeyman. Nevertheless, as the authors know all too well, global health is part and parcel of a more complex neoliberal regime, one that cannot operate without local agents that facilitate and participate in its celebratory parade. As Jean-François Bayart famously argued in his 1989 book L’État en Afrique: La Politique du Ventre, we should not overlook the actions of the African ruling elite in our analyses of the moral economy of resources and opportunities, but that is perhaps material for the book’s sequel.
The reader is left haunted by the abandoned, dusty and sometimes burnt items – files, charts, patient records – waiting to be sorted out and saved from oblivion or destruction, and whose ‘guardians’ (Derrida 1996, 2) are ordinary individuals keen on saving the genealogy and memory of these institutions. For what purpose do they do this, one might ask? Jacques Derrida (ibid., 36) would have concurred with the authors that the answer lies in the future, for the ‘question of the archive is not, we repeat, a question of the past. … It is a question of the future, the question of the future itself, the question of a response, of a promise and of a responsibility for tomorrow’.
About the author
Joelle M. Abi-Rached is a doctoral candidate in the history of science at Harvard University. Her thesis explores the traces of pathology and modernity in the Middle East through the history of one of the first modern psychiatric hospitals in the region. She was originally trained as a medical doctor at the American University of Beirut and holds an MSc in philosophy and public policy from the London School of Economics and Political Science. She co-authored with Nikolas Rose Neuro: The New Brain Sciences and the Management of the Mind (Princeton University Press, 2013).
Apel, Dora. 2015. Beautiful Terrible Ruins: Detroit and the Anxiety of Decline. New Brunswick, NJ: Rutgers University Press.
Bayart, Jean-François. 1993. The State in Africa: The Politics of the Belly. Translated by Mary Harper, Christopher Harrison, and Elizabeth Harrison. New York: Longman.
Dawdy, Shannon Lee. 2010. ‘Clockpunk Anthropology and the Ruins of Modernity’. Current Anthropology 51, no. 6 (December 1): 761–93. https://doi.org/10.1086/657626.
Derrida, Jacques. 1996. Archive Fever: A Freudian Impression. Chicago: The University of Chicago Press.
Foucault, Michel. 2004. Naissance de La Biopolitique: Cours Au Collège de France (1978–1979). Edited by François Ewald, Alessandro Fontana, and Michel Senellart. Paris: Gallimard.
Nora, Pierre. 1989. ‘Between Memory and History: Les Lieux de Mémoire’. Translated by Marc Roudebush. Representations 26 (Spring 1989): 1–24. https://doi.org/10.2307/2928520.