Saturday, 17 October 2009

In(/out) sights – empirical research on the human right to essential medicines in Tanzania and Kenya.

For a change I’m not meant to post on the Advanced Legal Studies @ Westminster blog about philosophy. In fact I have been urged to reflect upon and disclose the empirical work I undertook during July and August 2009 in Tanzania and Kenya, as part of my PhD research on “The 'Human Right to Essential Medicines' in Sub-Saharan Africa: A Critique”.

First and foremost: it did happen. When I landed after a series of connection flights and met Emmanuel, my would-be ‘institutional host’, at the airport, I could not but shout out: “Emmanuel, is this really Dar es Salaam??” The fact is, I had been planning the trip for more than two years but I was caught in the bureaucratic limbo of getting a research permit from the competent Tanzania authority (COSTECH).

It did happen: I managed to conduct more than 50 relevant interviews about access to medicines, healthcare, human rights, with officials from the Tanzanian government (central and local), international organisations, non-governmental organisations, foreign aid etc. – the people with whom I exchanged emails now shaking my hand, laughing and openly talking with me.

It did happen, I managed to travel up-country, visiting the “rural areas where access to medicines is particularly deficient”, a formula I had used with exhaustion in the chapters of the thesis I had already written – and that now would manifest itself in sometimes Kafkaesque realities.

It did happen, I explored the Accredited Drugs Dispensing Outlets (ADDOs)/ Duka la Dawa Muhimu, the new Tanzanian project for access to quality medicines in underserved areas – the case study I had selected.

How did it happen? Background reading spanning books, journals, newspapers, any report written on health care and access to medicines in Tanzania; tracking down the people mentioned in those reports; participating at the meeting of the Tanzania society in London; working on contacts thence information thence contacts thence information. To be acknowledged, most important had been one contact, Emmanuel Alphonce. I met him as he was taking an MSc in Public Health in Leeds in 2007. He was TFDA ADDOs coordinator then and I interviewed him several times in Leeds and London. Now a manager at TFDA, he has become my institutional facilitator in the Authority, which provided me with essential organisational support. Quite exemplary, I came across Emmanuel in the first place through the combination of research and networks. He is friend to another friendly Tanzanian I met at Tanzanian President Kikwete’s visit to the Tanzanian diaspora in London. I had found out about the visit from the Tanzania High Commission website. Why had I visited the website? Why not?

So why did it happen? In fact, my thesis is mainly a theoretical enquiry. I examine international human rights law and utilise Luhmann’s theory of social systems ultimately to critically analyse the ethical implications of the “human right to healthcare and medicines” in Africa. The empirical side is nonetheless fundamental. And with the trip I was not merely investigating the context of health care in Tanzania and Kenya. Ethics is affections, languages, values, philosophies, the daily life. People. My empirical enquiry, in effect, lingered on another level. I was a traveller thence I could easily approach people. [Just as easily I could distance them. Excitement and compunction, travelling accelerates life.] During the interviews, I was methodically and voraciously asking precise, technical questions on various aspects of access to medicines. Yet, at the same time, I was undertaking a meta-research on what I could dub the anthropology of ‘access to medicines’, of medical care, of health policies – and more intimately an ‘anthropology’ of my encounters.

Thus the empirical work has operated in dialectic with the theoretical study. Apparently, I chose Luhmann’s social systems theory because of a certain perception of reality which was developed through academic research as well as life. The theory pre-existed this visit to Africa and helped me as a critical-analytical tool in appreciating the empirical findings. The trip, in turns, contributes to build on the theory. In sum, the dialectic is aimed at deconstructing the social systems and subsystems (e.g. the legal, political and moral subsystems), revealing the realities and subjectivities which are often demoted by the standardised communications of ‘access to medicines in Africa’. In the thesis I critically analyse and elaborate such in(/out)sights, problematising and paradoxifying the international ‘human right to essential medicines’.

In the pictures:
1) Travelling to Sumbawanga (Rukwa region, Tanzania), from Dar es Salaam to the westernmost border with Zambia.
2) Exploring village public dispensaries in the Sumbawanga municipality.
3) A Duka la Dawa Muhimu with its TFDA licensed shop-keeper in Kilombero district (Morogoro region, Tanzania).

1 comment:

John Flood said...


This is excellent! Thanks for taking the time to write this. It's surprising how much one learns from stories of people's research.

I hope the other students take up the challenge too.