"Not here": making the spaces and subjects of "global health" in Botswana

Cult Med Psychiatry. 2011 Jun;35(2):285-312. doi: 10.1007/s11013-011-9209-z.


This essay argues that what makes "global health" "global" has more to do with configurations of space and time, and the claims to expertise and moral stances these configurations make possible, than with the geographical distribution of medical experts or the universal, if also uneven, distribution of threats to health. Drawing on a study of public-private partnerships supporting Botswana's HIV/AIDS treatment program, this essay demonstrates ethnographically the processes by which "global health" and its quintessential spaces, namely "resource-limited" or "resource-poor settings," are constituted, reinforced, and contested in the context of medical education and medical practice in Botswana's largest hospital. Using Silverstein's work on orders of indexicality, I argue that the terms of "global health" are best understood as chronotopic, and demonstrate how actors orient themselves and others spatio-temporally, morally, and professionally by using or refuting those terms. I conclude by arguing that taking "global health" on its own terms obscures the powerful forces by which it becomes intelligible. At stake are the frames within which medical anthropologists understand their objects of study, as well as the potential for the spaces of "global health" intervention to expand ever outward as American medical personnel attempt to calibrate their experiences to their expectations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / epidemiology
  • Acquired Immunodeficiency Syndrome / therapy
  • Anthropology, Cultural / education
  • Botswana
  • Conflict of Interest
  • Cultural Competency
  • Curriculum
  • Delivery of Health Care / organization & administration*
  • Developing Countries*
  • Education, Medical*
  • HIV Infections / epidemiology
  • HIV Infections / therapy
  • Health Resources / organization & administration
  • Health Services Needs and Demand / organization & administration
  • Humans
  • Internationality*
  • Morals
  • Physician's Role
  • Professional Competence
  • Public-Private Sector Partnerships / organization & administration
  • Quality of Health Care / organization & administration*