Abstract
This research article examines the relationship between infrastructural instability and laboratory work in a public referral hospital in Sierra Leone. Drawing on ethnographic fieldwork conducted inside the hospital’s wards and clinical laboratory, I show how attending to infrastructure and materiality (i.e., laboratory spaces, diagnostic equipment, and supply chains) provides insight into the different kinds of value that laboratory work holds for laboratory technicians, clinicians, hospital administrators, and international donors. Through the case study of a newly arrived non-functioning diagnostic instrument, I reveal the institutional undervaluing of both the laboratory and the improvisation work performed by lab technicians to stabilise unstable equipment. Infrastructural instability in the laboratory enables the generation of new kinds of value, including economic and social value for laboratory technicians themselves, but undermines the clinical value of laboratory tests for clinicians and patients. By discussing the everyday practices, challenges, and meanings of laboratory work in a context of infrastructural instability, I aim to draw attention to the clinical laboratory space as a field site worthy of (more) anthropological inquiry and health systems research and contribute new insights about improvisation, instability, and diagnostic value creation in under-resourced settings.
Highlights
This research article examines the relationship between infrastructural instability and laboratory work in a public referral hospital in Sierra Leone
‘Us, the lab technicians, we are important, but people don’t know; for the doctors we are their sorcerers, we investigate for them and tell them, “This is the problem for your patient.”’ — Laboratory technician, Freetown, February 2019
The Ebola outbreak exposed significant gaps in Sierra Leone’s laboratory system, prompting a wide range of international assistance in terms of emergency preparedness and laboratory strengthening efforts during the outbreak and its aftermath (Wurie 2016). These investments included, for example, the provision of mobile laboratories meant to upscale Ebola in-country diagnostic capacity; technical assistance in the development of nationallevel laboratory and surveillance systems as well as policy frameworks; and infrastructural investments to refurbish or build entirely new laboratories, hospitals, and training programmes (Vernooij et al 2020). What do these infrastructural investments tell us about the value of laboratory work fornational governments and donors? And how do refurbished laboratory spaces, new diagnostic instruments, and laboratory supplies affect the value of laboratory work for laboratory staff, clinicians, hospital administrators, and patients? In this research article, based on ethnographic research conducted inside the clinical laboratory of Sierra Leone’s main public referral hospital, I explore the everyday practices, challenges, and meanings of conducting laboratory work during a period of post-Ebola laboratory strengthening efforts
Summary
I have integrated information about historical investments in laboratory services in Connaught Hospital with that of investments in Sierra Leone more generally so as to situate the discussion of the value of laboratory (or lab) work in a wider politicaleconomic context. Connaught’s laboratory staff were involved as phlebotomists—they drew blood samples from Ebola-suspected patients in the King’s Sierra Leone Partnership (KSLP)-managed holding unit and ran other laboratory tests for the few non-Ebola patients who continued coming to the hospital.
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