Making Uncertainty

Tuberculosis, Substance Use, and Pathways to Health in South Africa

By Anna Versfeld

SERIES: Medical Anthropology

Rutgers University Press

In Cape Town, South Africa, many people with tuberculosis also use substances. This sets up a seemingly impossible problem: People who use substances are at increased risk of tuberculosis disease; and substance use seems to result in erratic behavior that makes successful treatment of people affected by tuberculosis extremely difficult. People affected don’t get healthy, healthcare providers are frustrated, and families seek to balance love and care for those who are ill with self-protection. How are we to understand this? Where does the responsibility for poor health and healing lie? What are the possibilities for an effective healthcare response? Through a close look at lives and care, Making Uncertainty: Tuberculosis, Substance Use, and Pathways to Health shows how patterns of substance use, tuberculosis disease, and their interaction are shaped by history, social context, and political economy. This, in turn, generates new perspectives on what makes poor health, and what good care might look like.

This is an outstanding ethnography that makes important contributions to medical anthropology specifically in relation to infectious diseases, substance use, and anthropological studies of global health practices and interventions. The nuanced anthropological focus on the intersections of substance use and tuberculosis among marginalized and impoverished persons that Versfeld analyzes in relation to historical legacies of colonialism and Apartheid is both in-depth and accessible. Critical reading for medical anthropologists, global public health scholars, and those interested in health inequalities in Africa and the Global South. Erin Koch, author of Free Market Tuberculosis: Managing Epidemics in Postsocialist Georgia

South Africa has among the highest tuberculosis rates in the world, related to indoor residential crowding, occupational hazards like mining, and high background HIV prevalence. Drug resistance and active TB resurgence magnify the original problem, increasing costs of care and reducing survival. I recommend this important contribution for anyone seeking deeper insights into the healthcare and community challenges facing the syndemic of substance use and TB, often complicated by HIV co-infection. Only a multifaceted response is likely to succeed for a disease too often addressed with limited ‘vertical’ programs. Sten Vermund, the Anna M.R. Lauder Professor of Public Health, and Dean of the Yale School of Public Health

ANNA VERSFELD is an independent South African medical anthropologist. She consults globally on social dynamics of tuberculosis, vulnerable populations, and people-centered healthcare provision.

Series Foreword by Lenore Manderson
1 Returners
2 The Stickiness of Moral Opinion
3 Co-constitutions: Makers and Maskers
4 Salience and Silence: Data, Evidence, and the Making of Figure Facts
5 The Challenge of “Unruly” Patients
6 Care to Cure
7 Catching Breath: The Hospital as Restricted Respite
8 Anthropology in Action
Acknowledgments
Notes
References
Index

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