Universitas Indonesia Conferences, 7th International Symposium of Journal Antropologi Indonesia

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Displacing the ‘Normal’: Uncertain Evidence and Pathologies of Tuberculosis
Clare Cameron

Building: Soegondo Building
Room: 126
Date: 2019-07-25 01:00 PM – 02:30 PM
Last modified: 2019-06-18


In recent work, Das (2015) asks: “Can a disease be normal?” (22). The question of the normal – and the making of the normal or ordinary – is one I often returned to over the course of my time working in Timika, West Papua, where I partnered primarily with the local implementing partner of USAID’s tuberculosis control program. In health centers throughout Timika, an anti-tuberculosis slogan warns, Bukan batuk biasa!. The unintended implication of this slogan is to suggest that there is something called a normal cough – tuberculosis just is not it. A confluence of factors – environmental, social, and economic displacements – do produce something that might be called a common, even normal, cough in Timika. Yet, without consistent access to other screening technologies (e.g. chest x-ray or Gene Xpert) community health workers simply screen for suspected undiagnosed TB patients with the question: Have you had a cough that has lasted longer than two weeks? In this way, a sputum microscopy-screening event in a city with high TB prevalence can test two hundred “suspected” adults and yield zero positive results. The epistemic valence of evidence refracts through the ‘normal’ such that global paradigms for TB prevention and screening, which index a prolonged, productive cough as clinically suspicious for TB, fail to fully account for the situated meaning of what it might mean to have a cough. A shift in what constitutes the ‘normal,’ thus, also shifts the interpretation or signification of events, such that a chronic cough no longer indexes as pathological. In this paper, I explore the ways in which epistemologies of public health obscure a series of compounding displacements central to an understanding of tuberculosis epidemiology.