Week 6 Flashcards
(30 cards)
Tb in SA 2006
Multidrug-resistant tuberculosis (MDR-TB) is a form of tuberculosis
caused by bacteria that are resistant to at least isoniazid and
rifampicin, the two most effective anti-TB drugs. This resistance
complicates treatment, making it longer, more expensive, and
potentially more difficult.
Extensively drug-resistant tuberculosis (XDR-TB) is a form of
tuberculosis (TB) where the bacteria are resistant to the most
effective anti-TB drugs.It’s a more serious form of multidrug-
resistant tuberculosis (MDR-TB), with poorer treatment outcomes.
* Migrant labour system, mining industry
* Cape Town is a hotspot
* Khayelitsha est. population +- 250000 ppl
* SA Doh favour DOTS System
* =Direct Observed Therapy Short Course
Challenges of increase drug resistant TB
Increased resistance to frontline TB drugs
Inaccesible treatment options
Migration
Inadequate healthcare services
Patient ‘nonadherence’ (aka defaulting)
Incompetent or uncompassionate health care workers
Migration to the private sphere
Reading 1:
Abney, K., 2018. “Containing” tuberculosis, perpetuating stigma: The materiality of N95 respirator
masks. Anthropology Southern Africa,
Reading 1: Context & Objective
Kate Abney’s article explores how N95 respirator masks, distributed to
patients with drug-resistant tuberculosis (TB) in Khayelitsha, South
Africa, function not only as medical tools but also as social objects with
profound symbolic, material, and stigmatic effects. Drawing on
ethnographic fieldwork among TB patients and support groups, the
study critiques the unintended social consequences of global health
protocols, particularly how these masks become containers not only of
disease but also of stigma.
Reading 1: Theoretical Framework: “Containment” as a Heuristic Tool
Abney uses the concept of containment in dual senses:
Medical containment: Masks as literal containers preventing the
spread of TB.
Social containment: Masks as markers that contain stigma, shaping
public perceptions and patient experiences.
This draws on actor-network theory (ANT) and boundary object theory
to show how material objects like masks mediate between biomedical
protocols and everyday social life.
Reading 1: Materiality and Symbolism of the N95 Mask
The N95 mask is bulky and covers a significant portion of the face, making wearers hyper-visible.
Its distinct appearance, unlike the more common surgical mask, marks wearers as “dangerously” ill.
Patients described themselves as “ghosts standing up” or “thieves,”
due to the dehumanizing visual impact of the mask.
The mask interrupts normal face-to-face interaction, leading to “loss of
face” — both literally and metaphorically, echoing Goffman’s (1967)
ideas of social identity.
Reading 1: Stigma and Social Visibility
Abney distinguishes between:
Felt stigma: Internalized shame and fear of social exclusion.
Enacted stigma: Actual discrimination and negative reactions others.
from
Wearing the mask in public spaces like taxis or homes was seen as a
public declaration of illness, often met with fear or ostracization.
Patients strategically chose when and where to wear masks to avoid
discrimination, creating tension between health compliance and social
survival.
Reading 1: Ethnographic Evidence from Support Groups
Participants shared stories of physical discomfort and emotional
distress tied to mask wearing.
The mask was often removed in intimate family settings, despite the risk of transmission, to preserve social roles, especially among mothers Patients described “Big TB” (drug-resistant TB) in contrast to “normal” TB, with the N95 mask as its visible symbol.
Reading 1: The Mask as a Negative Boundary Object
Drawing on Fox’s (2011) concept, the N95 mask fails to harmonize the two communities it bridges:
Biomedicine, which views it as protective.
Everyday social life, where it becomes a source of shame and exclusion. Instead of facilitating understanding, it disrupts communication and
social norms, exacerbating patients’ vulnerability.
Reading 1: Cultural Context and Comparative Perspectives
Unlike in East Asian societies (e.g., Japan), where mask-wearing is normalized and often preventive, South Africa lacks a “mask culture”. This cultural absence means masks are interpreted almost exclusively as signs of illness, further alienating wearers.
Reading 1: Policy and Ethical Implications
Mask mandates, while grounded in biomedical necessity, often
disregard sociocultural realities.
Abney argues for more nuanced public health strategies, co-designed
with patients to reduce stigma and improve compliance.
Suggests that patients who are no longer infectious might transition to
less visible masks, avoiding unnecessary social penalties.
Reading 1: Conclusion
Kate Abney’s study powerfully illustrates that the material and
symbolic life of objects—here, the N95 mask—can reinforce social
hierarchies, stigmatize illness, and complicate public health efforts.
For anthropologists, it is a compelling case of how biomedical
technologies intersect with local moral worlds, and how global health
interventions must reckon with cultural meaning, identity, and lived
experience.
Reading 2:
Macintyre, Kate and Emily Bloss. 2011. Alcohol Brewing and the African Tuberculosis Epidemic.
Medical Anthropology,
Reading 2: Overview
This editorial investigates how alcohol production and consumption,
particularly in informal urban settings in Kenya, contribute to the African
tuberculosis (TB) epidemic. The authors argue that small, crowded, and
poorly ventilated spaces where local alcohol is brewed and consumed significant and overlooked environments in the transmission and
are
progression of TB
Reading 2: Alcohol and TB: A Biological and Social Connection:
About 10% of global TB cases are attributable to alcohol use.
Alcohol weakens the immune system both directly (through its toxic
effects) and indirectly (via malnutrition).
Alcohol consumption leads to:
Delayed health-seeking behavior
Poor adherence to treatment
Higher infectiousness, especially in heavy drinkers
Reading 2: Space, Place, and Risk: Bars and Breweries
The focus is on Mama Pima (a Kiswahili term meaning “the colloquial term for women who brew and sell alcohol.
These brewing sites (bars, backrooms, sheds) are often overcrowded,
measurer”)—a
smoky, and poorly ventilated, creating ideal conditions for airborne TB
transmission.
The production process itself (with fires, no chimneys, and indoor brewing)
further exposes women brewers to health risks.
Reading 2: Gendered Economies: The Role of Women Brewers
Brewing is both an economic survival strategy and a cultural practice for many urban poor women, particularly in northern Kenya Samburu, Isiolo, Marsabit).
Brewers are often:
Poor
Recent migrants
Heads of households
Their work is entrepreneurial (e.g., selling delivery) but also places them at high health risk:
takeaway shots, providing home
Greater exposure to TB environments
Often co-infected with Involved in HIV
risky sexual behaviors linked to the alcohol trade
Reading 2: Emperical findings of Northern Kenya
Case-control studies found that TB patients were six times more likely to be brewers than non-TB controls.
Brewers had:
Greater daily exposure to smoky, enclosed brewing spaces
Frequent interaction with heavy drinkers (often high TB risk)
Many reported limited knowledge of TB transmission, despite recognizing
the unsanitary conditions of their environment.
Reading 2: Historical Parallels and Broader Context
The authors compare Kenya’s current urban TB crisis to industrial Britain, where rapid urbanization, poverty, alcohol, and coexisted.
The article suggests TB is not just a medical issue but a social disease, thriving in conditions of inequality and displacement
Reading 2: Critical Reflections for Anthropologists
TB is shaped not just by pathogens but by social environments, economic
structures, and cultural practices.
Anthropology can reveal who is most at risk, why, and what kinds of interventions might actually work.
Intervening in brewing culture is ethically complex: many women brew alcohol to survive, not because they choose risky behavior.
Legal reforms (like Kenya’s 2010 Alcohol Bill) may help regulate brewing, but
implementation is uncertain without community engagement and culturally
sensitive public health strategies.
Reading 2: Conclusion and Call to Action
TB prevention programs must look beyond clinical treatment to address
social determinants like informal alcohol production.
The article urges medical anthropologists to:
Investigate brewing spaces as sites of infection
Understand brewers’ motivations and constraints
Inform ethical and practical public health interventions
Reading 3:
Majombozi, Z., 2019. Care, contagion and the good mother: narratives of motherhood,
tuberculosis and healing. Anthropology Southern Africa
Reading 3: Research Focus
Majombozi explores how tuberculosis disrupts the lives and identities of black working-class mothers in Khayelitsha, South Africa, focusing on two
women, Andiswa and sis Thembi. She investigates the narratives of illness,
the socioeconomic dimensions of mothering, and how TB treatment
intersects with care work, structural violence, and gendered moral
expectations.
Reading 3: Biographical Disruption and Illness Narratives
Drawing on Arthur Kleinman and Michael Bury, Majombozi frames TB as a
biographical disruption—a moment that fractures a person’s life trajectory,
identity, and ability to function in socially prescribed roles (like motherhood).
Illness narratives help the women make sense of their suffering, contextualize
their experiences, and reclaim some control and coherence in their lives.
These narratives balance moments of “burdening” (distress, guilt, disruption)
with “unburdening” (relief, support, hope).
