Pluripotent trajectories: public oncology in Rwanda

Abstract

This article examines how Rwandan patients understand and represent cancer, as well as how state actors articulate the agenda of public oncology and related expectations of citizens. Patients view cancer and infection as co-existent and processually intertwined. This elides with the reality of epidemiology on the ground, as the local burden of disease encompasses both infectious and noncommunicable diseases. Further, patients still consider the efficacy of occult acts in causing tumors, particularly in the face of a disease marked by etiological uncertainty in the biomedical realm, and frequent resistance to treatment. At the same time, both policy makers and clinicians servicing public oncology expect citizens to quickly relinquish any beliefs in the occult and fully embrace a biomedical value system. Beyond the fact that this project cannot be fulfilled, its articulation only limits the ability to envision a more capacious framing of oncology which acknowledges both the limits of treatment, and the diverse ways in which patients suffering from cancer make meaning in the face of grave illness.