Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital by Alice Street (review)

Abstract

Alice Street, Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital. Durham: Duke University Press, 2014. 328 pp.The anthropology of biomedicine and science and technology studies share a number of guiding questions. The first is ontological: how do medicine and science their objects? The second is political: how do social relations participate in the production of those objects? Another is material: what are necessary in order to stabilize medical/ scientific objects and them perform as expected? Alice Street's excellent new ethnography of Madang Hospital in Papua New Guinea (PNG) pulls fresh insights from these enduring problems, showing what happens when indigenous procedures for making up (Hacking 1999) encounter unstable bio-scientific in a weak state.Papua New Guinea attained independence from Australian rule in 1975. In the decades leading up to that thoroughly expected and carefully planned transition, many outside observers-not least the Australians preparing to leave what was then the Territory of Papua and New Guinea- were skeptical that nationhood was desirable or, indeed, possible. Their skepticism was frequently grounded in concerns that the nation-building forces of a common language, a shared culture, and a general commitment to modernity did not exist among the country's many hundreds of largely autonomous cultural groups. According to these observers, the Independent State of Papua New Guinea was a political experiment with the potential to go horribly wrong.Alice Street's Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital uncovers the long history and contemporary consequences of PNG's production as a site of medical, political, and social experimentation. Street dismantles a pervasive myth about the health sector in PNG, one that continues to guide development and aid interventions in the country: that the system's present of decay is an index of post-colonial state failure, a sign that the dreams of modernization that accompanied Independence have proven hopeless. On the contrary, Street argues that...the dream of the modern Papua New Guinean hospital was unraveling as quickly as the blueprints were being turned into timber frames and concrete blocks...contemporary narratives do not capture the longue duree of ruination; inequality, depravation, and dilapidation were built into the new hospitals from the start. (78)The World Bank-mandated structural adjustment programs that wreaked such havoc on the public sectors of the developing world in the 1980s and 1990s were, in the case of PNG, merely one of many experimental moments in the country's history. Since the start of their existence as mandated territories following World War I, Papua and New Guinea were construed as experimental spaces (53) defined by makeshift infrastructures (48) and ambiguous governance. This ambiguity has consequences for how Papua New Guineans experience the state-the hospital being a key site of citizens' encounters with government-and how different modalities of personhood are elicited in the process.A former advisee of Marilyn Strathern, Street applies a Strathernian analytic of Melanesian ontology in remarkably effective ways. Street describes people in Madang Hospital struggling to themselves into objects of another's regard: patients, doctors, nurses, and family members all work-not always successfully-to make themselves visible (reify themselves) as particular kinds of bodies or persons in the expectation of eliciting a productive relationship (24). They attempt to do this through the visualizing and entextualizing technologies of modern biomedicine: patient charts, X-rays, blood tests, and other forms of diagnostic evidence. However, due to the instability of the local and national upon which these technologies depend, attempts at reification and diagnosis seldom work as expected. …