Disrupting the fatal sleep: innovation and the elimination of Human African Trypanosomiasis in Northern Uganda
Lee, Shona Jane
For more than a century, a wide variety of tools, techniques, and strategies have been deployed in attempts to control Human African Trypanosomiasis with mixed success. However, the recent development of more simple and cost-effective diagnostic devices, drug candidates, and vector control methods have culminated in renewed political commitments toward eliminating the disease. This thesis draws on ethnographic case studies of these ‘contemporary and emerging strategies’ (Steinmann et al. 2015) at a critical moment between implementation and scale; where technologies form relationships and take on social connotations, and where policy struggles to become practice. These multi-sited studies provide empirical examples of how technologies of global health become commodities of governance, and objects of expertise, controversy, and advocacy. This study critiques the global health community’s fixation on technology as the harbinger of progress in sleeping sickness control, and argues that solutions continue to be overly simplistic and attentive to discrete devices. In doing so, programmes overlook the dynamic systems that govern technologies’ social proximity to people. Case studies on diagnostics and tsetse control illustrate how socially embedded technologies can become tools of advocacy by promoting horizontal forms of knowledge production and exchange. The social proximity of interventions are key drivers of sustainability, as more community embedded technologies take on, and persist through social lives of their own. Examining diagnostic capacity in the passive surveillance system reveals how infrastructures are relational as well as material, thus technology alone cannot address infrastructural paucity. Global commitments to collaborative ‘One Health’ approaches to eliminating HAT disentangle in practice and become fragmented at the point of implementation. Decentralised and under-resourced district offices struggle to maintain operational cohesion, as a precarious network of health workers, entomologists, and veterinarians struggle to align vertical programmes with local priorities. In summary, this study reveals HAT control as a fragile assemblage of actors operating in environments of uncertainty, and explores how introducing new technologies into these socio-technical ecosystems can disrupt and transform them in unpredictable ways. Due to the dominance of top-down technocratic approaches in global health, anthropological contributions to HAT programmes are widely underutilised (Bardosh, 2014). This thesis advocates critical, multidisciplinary approaches for developing adaptive, locally specific solutions to HAT in a landscape of elimination.