Reimagining Social Medicine from the South by Abigail H. Neely

Abstract

Reviewed by: Reimagining Social Medicine from the South by Abigail H. Neely Kwaku Nti Neely, Abigail H. Reimagining Social Medicine from the South. Durham, NC: Duke University Press, 2021. Foregrounded in social medicine (a branch in the medical field that focuses on demographic determinants of health and the biology of disease, as well as community-oriented primary care [COPC] that influenced the World Health Organization [WHO]–led primary health care for all), this book upholds the Pholela Community Health Center (PCHC) "unbecoming role." Significantly, yet, the author derives her ideas from the experiences of the proximate community—that is "the homes, landscapes, and lives—the worlds of Pholela residents" (xv). Abigail Neely, essentially, reiterates that it is conceptually impracticable to fully comprehend the global story of social medicine without the lives of the residents of Pholela, their homesteads, health, and words, since these elements proffer the possibilities and limitations of this field, and equally pushes for a more-than-human understanding of social life in illness and wellness. Arguably, in the cast of Charles van Onselen, who did a social history of the industrialized gold mining sector of the economy of South Africa and shifted the glorious attention from the mine owners to the underground miners and others in that category, Neely de-emphasizes "laudatory narratives of white male doctors who practice medicine to fight for social justice" (4) and centers Pholela residents as the people who lived in the community and made different worlds amid the vagaries of illness and wellness. She, therefore, juxtaposes the sacrosanct scientific study of PCHC with the understandings and interventions borne out of the worlds in which the Pholela people lived. Neely avers, and justifiably so, that these local and cultural understandings and interventions forged "health outcomes in ways social medicine could not always understand and treat" because "for all its many successes, the PCHC was haunted by its own faith in [End Page 220] science, both biomedical and social, as well as by broader political and economic forces at work in South Africa" (4). Elaborating on the limitations of the PCHC program, Neely discusses its inability to consider the role of the people in the development of the practice, disregard of the sociality of nonhuman things that remain integral to it, and the lack of understanding of Pholela-specific social relationships giving a deep "vision of social life in which individual actors disappear and health and illness emerge as the product of entanglements" (5). Connected to the foregoing factor is the idea of "ontological coordination"; for the residents of Pholela, "ontologies are multiple, relational, and overlapping" (4), a kind of multiplicity that reveals yet another limitation to the social medicine practiced in the Pholela vicinity. Finally, the political ecology inflected by the scholarship on racial capitalism also illuminates some of the limits of social medicine practiced in Pholela. Although the health center could assist with modifications of the homesteads of the residents in addition to offering clinical care, it hardly could change the overarching structures of racial capitalism that heavily impacted livelihoods, illness, and wellness. Neely points out that to the extent that the political economy of South Africa was stratified by race, scholarship on racial capitalism is particularly valuable for a political-ecology analysis in Pholela. According to these scholars, capitalism, as well as capital accumulation, predicated a racial hierarchy that both government policy and industrial practices reinforced. The policies and practices culminated in Apartheid ensuring astronomical profit for whites at the expense of the well-being of African laborers. Reimagining Social Medicine from the South essentially consists of four chapters that are bookended by the introduction and conclusion. In chapter 1, Neely discusses her sources that mainly include archival documents, PCHC publications, and regional ethnographies of the Nguni people. While not discounting the biases and problems of these various sources, she affirms that in varying degrees, they are helpful for understanding the vision of social medicine that the PCHC practiced. She uses these sources to tell the story of the beginnings and operations of the PCHC and concludes that "seeing like a health center meant making certain aspects of health center practice visible to the outside world, all while recognizing how...