Rutgers Historian Opens Window on Hope in African Cancer Ward

Credit: Courtesy of Julie Livingston

Julie Livingston, far right, with staff at Princess Marina Hospital, where spent a sabbatical year and three summers observing and listening.

Growing up in the home of an oncologist who ran a cancer lab, Rutgers historian Julie Livingston always thought the worst part of cancer was the treatment ? the chemotherapy, surgical scars, wigs, pills and debilitating fatigue.?

That changed in 1997, when accompanying a public health team on a patient home visit in Botswana in southern Africa, she encountered a boy with a huge, disfiguring growth that was killing him as he ?slowly, silently writhed in agony. ? I stood stunned by the spectacle, unsure of what I was seeing,? until a friend and co-worker ?whispered the word cancer in my ear, with familiar gravity.?

At that moment, Livingston had an epiphany. ?I realized for the first time in my life, I was seeing untreated advanced cancer ? that is, cancer without oncology,? though the disease and its treatment had always been inextricably linked in her imagination.

Over the next 15 years Livingston, a historian with interdisciplinary training in public health and anthropology, would witness many such scenes, including during months spent at a small cancer ward in Gaborone, the capital of Botswana.

The result is an affecting ethnography, Improvising Medicine: An African Oncology War in an Emerging Cancer Epidemic, recently published by Duke University Press. In it, Livingston tells the story of Botswana?s only dedicated cancer ward, as a cancer epidemic emerged in a country about the size of Texas (though with a considerably smaller population), reflecting the surge in cancers across the global south.

Livingston, an associate professor of history in the School of Arts and Sciences, spent a sabbatical year and three summers observing and listening at Princess Marina Hospital. Sometimes she was a fly on the wall, quietly taking notes as patients battled with cancer and as their doctors, nurses, friends and relatives struggled to treat and care for them. She also listened to people?s stories, ran errands to the pharmacy, chauffeured patients and their relatives around the city, translated doctors? pronouncements from English to Setswana and patients? questions from Setswana to English.

The epidemic in Botswana unfolded against the backdrop of real medical progress in drugs used to treat and prevent infection with HIV, the virus that causes AIDS, among adults.

?People who once died of AIDS in Botswana now live long enough, thanks to anti-retroviral drugs, to become cancer patients,? Livingston says. ?As a consequence of the country?s success in dealing with the AIDS epidemic, Botswana ? and Africa ? now faces a new epidemic of cancer that has been largely ignored by the developing world.?

Many Batswana (the country is BOTswana; the people are BATswana) have firsthand knowledge of AIDS patients restored to life, if not perfect health, by medical science, and they hope for something similar when cancer strikes them or a loved one.

But in Botswana, Livingston says, doctors can only use drugs for which patents have expired or those donated by pharmaceutical firms. They must often use outdated equipment, nursed along passed its service life. And relief from the pain of cancer and its treatment is hard to come by.

Painkillers, though off-patent and inexpensive, are tightly controlled under anti-narcotic laws and usually not the focus of international medical aid, which concentrates on medical research and public health issues.

Patients at Memorial Sloan-Kettering Cancer Center in New York and patients at Princess Marina Hospital in Botswana face the same existential, temporal and moral questions that trouble cancer patients everywhere, Livingston notes. But their experiences and challenges are different, given that Botswana has a system of universal care and an uneven technological field, while Sloan-Kettering is a site of research and heavy capital investment yet remains out of reach for so many.

?The problems of pain, death illness, disfigurement and care ? are basic human ones,? she writes in Improvising Medicine, noting that where cancer is concerned, Americans have as much to learn from Batswana as Batswana do from Americans. ?

Livingston hopes people will come away from the book with a better understanding of the human stakes and challenges of an epidemic that will shape the future of global health.

?We in the global north look at Africa and, where health care is concerned, we say, ?We will go there and help them,?? Livingston says. "But if we look closely at a place like Botswana, we might learn something about cost, equity of care, death and existential angst. I want to break up the idea that Africa is so different and only an object of our pity or our salvation complex. I just don?t see it that way.?

Cancer is cancer, in Botswana or New Jersey.

?

Source: http://news.rutgers.edu/focus/issue.2012-11-01.3421334431/article.2012-11-14.1650537650/

pecan pie recipe prince philip sugar cookie recipe sugar cookie recipe how the grinch stole christmas macaroni and cheese festivus