Technocratic tuberculosis control: health professionals at the interstices of DOTS in Shanghai, China

Abstract

This thesis explores the entangled nature of human and non-human agencies in the making and maintaining of a global health programme in a local setting. Specifically, it investigates how public health professionals engage with and enact the technocratic management of tuberculosis control as per the DOTS approach in contemporary Shanghai. My research is based on a fourteen-month internship with the Shanghai Centre for Disease Control and Prevention (SCDC) and examines the mechanics of tuberculosis control in the metropolis at the municipal, district and community levels.

In this thesis, I show how non-human agents intrinsic to the functioning of DOTS – protocols, standards, numbers, technology, concepts such as ‘compliance’ and ‘scale’, inter alia – are both useful and risky. They bring consistency and accountability, assert compliance and conformity, but also set limitations for the project of recovery and cure. As such, considerable maodun (矛盾) or contradictions arise when technocratic policy and sick patients meet, and I demonstrate how these moments offer rich opportunities for understanding how DOTS operates in a local context.

Public health professionals are positioned in between policy and patients, and both occupy and constitute the interstices that separate and connect the two. I argue that they negotiate these moments of maodun to make DOTS fit for human use. I further suggest that they do so through their subjective engagement, exertion of emotional labour, and exercise of discretion in managing technocratic tuberculosis control. Entangled with the influence of non-humans, this thesis argues that the choices and actions of public health professionals inform the formation of their own interstitiality and, recursively, make and shape the nature of tuberculosis and its control for patients in Shanghai, for China, and for the Global Health project more widely.

Rooted in medical anthropology and the Shanghainese experience, this thesis contributes to wider discussions on the human and non-human in the co-production of knowledge, and the pivotal role played by individuals to exert profound influence within the larger and technocratic.