Person:

Djordjevic, Darja

In Africa, the effects of the HIV/AIDS pandemic, rapidly expanding industrial and extractive economies, uncontrolled economic growth, environmental and lifestyle changes, and the rising age of populations with better access to medicine have occasioned rising rates of cancer. Rwanda’s national cancer program has been hailed as a unique example of how to build clinical oncology into a public healthcare infrastructure. Using ethnographic data, interviews, and historical archives, I address three sets of questions: 1. What historical, economic, social, and political factors have shaped the development of the country’s cancer program? 2. How do local clinicians and patients experience cancer as a treatable chronic disease? And how is that experience affected by the development of a national oncology infrastructure and new biomedical technologies? 3. As an instance of the transnational private-public partnerships characteristic of global health interventions in postcolonial Africa, what successes, limitations, and challenges does this cancer program present for envisioning oncology programs elsewhere in the global south? What are the ethical, political, and epistemological stakes involved in different models of cancer care? This project contributes to a new chapter in medical anthropology, one focused on rising rates of cancer in contemporary Africa.

I argue that Rwanda’s cancer project is an exercise in the construction of a new sense of sovereignty, rendered through the politics of life as onco-nationhood; that it is an effort to create a postcolonial polity whose citizen body is gifted care of a international caliber provided by a paternal state. In a critical moment of post-traumatic social reconstruction, national biomedicine is becoming the entity through which government seeks to fuse sovereign statehood and nationhood in the cause of a healthy Rwandan future. Theorizing this relationship holds at least one key to developing an anthropology of cancer in contemporary Africa.

While it is widely accepted that cancer incidence is on the rise in Africa, and global oncology has burgeoned, the history of cancer and cancer research on the continent is generally not discussed. This thesis reviews data original research and policy statements on cancer in Africa from the 1950s til the early 1980s. The analysis herein seeks to unpack the movations for the etiological and epidemiological cancer surveys that seem to have risen to prominence beginning in the 1950s. It also charts the significance of racial difference as it was factored into the categorization, incidence, and outcomes of various cancers, and considers colonial perspectives on the difference between African and European cancer. This work also reviews issues of treatment and therapeutics as they arose (though rarely) during certain regional conferences. It reveals that certain proposals about developing oncology infrastructure bore striking similarity to those advanced in the 21st century in Rwanda. Overall, Africa was a living laboratory for understanding cancer in its ‘natural’ state—it was observable and describable in contexts where the various conditions of European civilized and industrialized life had not taken hold, so that it was easier to isolate environmental exposures related to local ecology and lifestyle. Thus, despite certain gestures toward the future of treatment, knowledge about cancerogenesis was largely extracted from African contexts for the purposes of advancing cancer epidemiology and geographic pathology.