Fake Drugs and Fugitive Science: Employing Ethnographic Methods to Explore Challenges to Global Health Policies around pharmaceutical use in Tanzania

Abstract

Powerful pharmaceuticals are readily available for purchase throughout Tanzania and global health policy makers decry this situation as dangerous and disordered, as if no rules govern the use of drugs in Africa. In the prevailing global health understanding, ‘truth’ lies in the laboratory science that goes into the making and proper prescription of drugs, and such deviations as ‘overuse’ and ‘misuse’ result from the fact that locals misunderstand what these drugs are and how they should be used. To investigate this global health concern, I employed a grounded ethnographic approach, carried out in the regional capital of Iringa, Tanzania. Over three years of fieldwork, I observed how embodied epistemologies frequently enabled my interlocutors to evaluate the quality of various drugs and identify substandard pharmaceuticals through their material qualities like color, texture, smell, and taste. In this talk, I focus on one prominent example in which patients recognized the poor quality of antiretroviral drugs (ARVs) that were produced by the Tanzanian Pharmaceutical Industry and distributed throughout public facilities. Patients and doctors shook capsules to determine which were still good, or in Dr. K’s words, “which ones were shaking well like sand,” and then exchanged sticky-texture pills for the sand-texture ones in order to continue treatment in the context of drug shortages. I conclude that ethnographic methods offer crucial correctives to global health policies—such as those seeking to “rationalize” drug use—in part by challenging the containment of empirical experimentation within spaces of global capital, laboratories, and the neoliberal state.