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Translating Technologies in Global Health Diagnostic Spaces Between Standardization and Adaptation in Uganda’s Malaria Control Programme

René Umlauf (U Bayreuth, Germany) and Uli Beisel (U Bayreuth, Germany)
Publication Date 2016
Publication SPP Working Paper No. 20
Publisher DFG Priority Programme (SPP 1448): "Adaptation and Creativity in Africa"
Language English
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Summary

The DFG funded research programme "Adaptation and Creativity in Africa" (SPP 1448) publishes online working papers in a PDF format. The editors are Ulf Engel (U Leipzig, Germany) and Richard Rottenburg (U Halle, Germany). All members and associates of the research programme are invited to publish their findings as SPP working papers. Please address any enquiries about form, scope, and procedure to: info@spp1448.de


Introduction
This paper examines the implementation and use of Rapid Diagnostic Tests (RDTs) for Plasmodium falciparum malaria at different access points for anti-malaria drugs in Uganda. These new technologies are assumed to bring evidence-based diagnosis and therapy closer to the homes of people living in remote areas where basic public health services are not available. This means that from a policy perspective the rollout of RDTs has the potential to increase accuracy and access to parasitological diagnosis and malaria care considerably. Access to care has been a dominant trope in global health over the last decades. The rise of the so-called „global health complex“ has increased not only the visibility of health care problems in economically deprived countries (McGoey, Reiss, and Wahlberg 2011), but also resulted in greatly increased funding for so called ‘neglected diseases’ (ibid; Kelly and Beisel 2011; Cohen 2006). New disease control schemes have sprung up on the continent, and improved access to care and reduced malaria case numbers have widely been recorded1 . In malaria control current global efforts have mainly been shaped by attempts to provide universal access to new first-line treatments like Artemisinin Combination Therapy (ACTs). However, from a biomedical and pharmacological point of view questions of access are inextricably linked to clinical treatment protocols where therapy is always preceded by adequate parasitological diagnosis. However, decades of neglect of biomedical malaria care in most endemic countries not only resulted in highly fragmented health infrastructures but are also characterized by the coexistence of a variety of treatment practices that complement and at times contradict clinical understandings of diagnosis / therapy nexus (Langwick 2007). But not only so called traditional medicine has relied on non-parasitological diagnosis, also in biomedical clinics a vast majority of malaria diagnoses have long been made based on symptoms of fever. Parasitological diagnosis via microscopy often remains out of reach for poor and rural settings as it requires costly laboratory equipment and expertise. Such infrastructural weaknesses are often compounded with understaffed clinics and high patient pressure. From a biomedical perspective this is worrying as it means many patients are not treated for the illness from which they actually suffer and that drugs might not be used rationally. Self-diagnosing and / or presumptive treatment with anti-malaria drugs are prevalent practices for managing the disease or the symptoms associated with it, leading to over- as well as under-diagnosis of malaria (Chandler et al. 2008). Our paper traces the epistemological and ontological changes the introduction and use of Rapid Diagnostic Tests (RDTs) has triggered in how malaria is diagnosed and subsequently treated. In this paper we examine the two assumptions that underlie the public health discourse on RDTs, namely that (i) rapid tests are easy to use and mobile, and so (ii) make standardisation of parasitological diagnosis possible across a variety of health care facilities. In what follows we first discuss the public health discourse on rapid diagnostic tests, second introduce our theoretical understanding of standardisation, and finally discuss three different technologies to diagnose malaria. In the three empirical vignettes on malaria microscopy, symptom-based diagnosis and rapid testing we focus on the technologies’ capacity to standardize and the work that is involved to accommodate and adapt the technology to the everyday routines in the health facilities.


Biographical Note
René Umlauf received his Ph.D. in Sociology from the University of Bayreuth in 2016. His research focus is on the relation between science, technology and organizations in the context of Global Health interventions. He is particularly interested in the question what role tests and testing procedures of different scale and scope play for the production of multiple forms of evidence. In his thesis, which he is currently turning into a book, René explores some of the epistemic and institutional implications the introduction of novel Rapid Diagnostic Tests (RDTs) for malaria brings to the organization of primary health care infrastructures in Uganda. In addition, insides from these explorations are linked back to questions of organisational learning in and around Global Health programs.

Prof. Dr. Uli Beisel arbeitet im interdisziplinären Feld der feministisch und postkolonial geprägten Science and Technology Studies, und der medizinischen und multispecies Anthropologie und Humangeographieverortet. Sie ist Associate Editor der Fachzeitschrift Science as Culture und Gründungsmitglied und Mitherausgeberin des Open Access Buchverlags Mattering Press. Mattering Press ist eine experimentelle Buchverlags-Plattform, die zum Ziel hat die Erreichbarkeit von akademischen Bücher im Bereich Science and Technology Studies zu fördern.