Based on an ethnographic study of health politics within and between institutions, the article gives an in-depth account of the political and economic causes of the epidemic, and the ironic situation that arose when Peru’s well-designed model program for drug-susceptible TB failed to confront the country’s growing problem of drug resistance. The problem was brought to public attention by a small NGO linked to Paul Farmer’s “Partners in Health” group based in Boston, which designed a grassroots out-patient approach to treating drug-resistant patients who would otherwise die. After initially difficult relations, the Peruvian Ministry of Health is now working in collaboration with PIH. Thanks to advocacy by PIH physicians, this new approach to drug-resistant TB has led to changes in global health policy, and efforts are underway to replicate the model in Russian prisons and other “hot-spots” where highly infectious drug-resistant TB threatens both patients’ lives, and the success of TB control programs.

Smith-Nonini conducted the research during a post-doctoral fellowship at Emory University that was funded by the Mellon Foundation.

For those who are interested: This link is to a shorter report on Smith-Nonini’s research that was published by Emory’s Center for the Study of Health, Culture and Society.

Smith-Nonini, who is secretary of the SAW, was also active with a group of anthropologists at the San Francisco meetings in developing a reform agenda to be presented to the American Anthropological Association Executive Board as the organization revises policies on labor with regard to annual meetings. The AAA recently relocated their annual meeting on short notice to avoid crossing the picket line at the San Francisco Hilton where UNITE-HERE union members were locked out in a labor dispute. The lock-out ended on the last day of the SAW meeting, just two hours before a scheduled rally where anthropologists joined members of the mostly immigrant service workers union on the picket line. The union and the Hilton have now resumed negotiations over wages and health benefits during a 60-day cooling off period. The Hilton’s losses due to the AAA meeting relocation was a pivotal issue in resolution of the dispute.

Smith-Nonini did the research for the study during a Mellon-Sawyer post-doctoral research project based at Emory University in 1999. The book was a project of Emory’s Center for the Study of Health, Culture & Society which devoted a 3-year period to the theme of emerging diseases and society. For her study, which compared responses to drug-resistant TB epidemics in two very different First World and Third World cities, Smith-Nonini travelled and conducted interviews with patients and public health experts in New York City, Lima, Peru, Boston (where Partners in Health has ties to a Lima-based health NGO), and Atlanta, headquarters of the U.S. Centers for Disease Control & Prevention.

See this Web site for more detail on the book.

She gave a similar version of the talk at the Society for North American Anthropology annual conference in Atlanta on April 24. Inspired by recent events in Iraq and Smith-Nonini’s former work in human rights in Central America, the paper brings an “anthropology of the body” to bear on explaining the compelling nature of images of injured and dead bodies, and the effectiveness of human rights as a form of humanitarian discourse in times of war.