In the most recent Our Changing World lecture, Dr Alice Street, Chancellor’s Fellow and writer of the recently released ‘Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital (Experimental Futures)’, outlined the value of anthropology in thinking about and planning infrastructure for health.
Initially, infrastructure was imagined as large physical structures designed to sustain industrial economies, for example power plants and grids, and physical telecommunications networks. However, as global priorities and expectations have changed, we now look to infrastructure to alleviate poverty and improve health in a socially just rather than financially driven sense. Infrastructure is mentioned within the Millennium Development Goals as ‘critical’ to the achievement of those goals, so as the imagining of development has changed, so has the imagining of infrastructure.
Globally, less developed and unstable states are seen as vulnerable due to a lack of centralised and managed infrastructure, but this narrative is being questioned, as it becomes clear that there is nothing necessarily more stable about this latter type of infrastructure. There is also an increased recognition of the creativity and resourcefulness of those living off the grid, where waste is reused and people take an innovative approach to creating economic opportunity from gaps in classically defined infrastructure. This combined with the fact that in the last few weeks, there have been cases of Ebola, which has so far taken 4000 lives since last December, reported in the US and in Spain. This again brings into question the perceived superiority of more traditionally centralised and managed infrastructures.
Dr Street talked about her fieldwork in Papua New Guinea, looking at the health infrastructure around a health centre located 5 hours’ walk from the nearest highway. Even ‘infrastructure-in-a-box’ solutions such as Rapid Diagnostic Tests for malaria, rely on use of technologies, previously learned protocols, and relationships of people to one another and to the environments they occupy.
For example, the health centre in question relied on local people to carry the tests from the highway to the health centre in large baskets. However, this process relies entirely on the relationships between the people doing that work and the health centre, who did not initially pay them for this, and their trust of the health workers in the centre. If they observed any failure in the health centre (be this through medical mistakes or equally through any scandalous social behaviours of health workers), they were far less likely to do this work. The health centre was then able to secure funding from the Global Health Fund to remunerate this work, which it was hoped would secure the necessary labour. However, the people carrying the medicines then questioned why they were not paid for transporting other medical supplies, such as the ‘regular’ antibiotics and drugs.
The main takeaway from the lecture was the value of anthropological perspectives on infrastructure, which allows us to consider that infrastructure is fundamentally about people and relationships between people, technologies, and the environment. Dr Street was able to put forward a convincing reconceptualization of infrastructure as the connections and relationships between people, technologies, and their environments. Infrastructure is indeed critical to changing the way we do things, and it is vital to use a lens that takes these factors into account, and to learn from the creative and innovative examples set by off the grid places.