Bioethics Blogs

Alice Street’s “Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital” by Mackenzie Cramblit

Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital

by Alice Street

Duke University Press, 2014, 204 pages

Social anthropologist Alice Street’s first book is an ambitious ethnography of personhood and recognition in Madang Hospital, an under-resourced provincial hospital in Papua New Guinea. The book shows how doctors, nurses, and patients endeavor to make themselves “visible” to others in order to initiate relations of care at multiple scales, while also emphasizing the uncertainties of diagnosis and treatment within an institution subject to perennial shortages of staff and supplies.

The book’s main section explores the treatment and experience of disease within the public ward of Madang Hospital. Street introduces the concept of “biomedical uncertainty” to describe how doctors must forego conclusive diagnosis and embrace a pragmatic approach to treating patients in an under-resourced setting. That this kitchen-sink method is the one best suited to the circumstances at Madang Hospital seems reasonable – after all, the doctors themselves say so. But Street’s optimistic claim that this “uncertainty…is another productive form that biomedical knowledge can take” and her apparent endorsement of what she terms “technologies of not knowing” feels out of step with the real ways doctors in this environment struggle to produce care amidst difficult constraints (111). What should be commended is the Madang doctors’ commitment to take action in spite of the prevailing biomedical uncertainty in their ward, not the uncertainty itself ­– the unenviable result of chronic resource shortages. It would seem essential to distinguish between this kind of uncertainty on the one hand and a positive strategy of diagnostic suppleness or nonclosure on the other.

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