From June 12-14, 2013, the American Anthropological Association’s Society for Medical Anthropology (SMA) and the European Association of Social Anthropologists’ (EASA) Medical Anthropology Network held a joint conference for their members, hosted by the Department of Anthropology, Philosophy and Social Work at the Universitat Rovira i Virgili (URV), Tarragona, Spain. The original conference description claimed that “location and format” would “promote the exploration of convergences and divergences between theories, practices, schools and regions across the broader community of medical anthropology scholars and practitioners globally.” In this regard, the conference did not disappoint. The location of the conference was, to say the least, humbling. It is quite challenging to one’s pretenses of democratic pedagogy and critical scholarship (common symptoms of studying in an American liberal arts college or teaching in an inter-disciplinary anthropology program) to find oneself on a university campus where even the walls of the courtyard serve as an undeniable testament to the radical politics and intense social engagement of the student body. While there remains a great deal to be said about URV as an institution and as a model for engaged scholarship, this essay will focus on the format of the EASA/SMA conference—a format that was unique, posed new challenges, and, in my experience, also generated something quite unexpected in the end.
The call for abstracts for the EASA/SMA joint conference, circulated in January 2013, indicated that submissions would only be accepted as individual papers, not as pre-organized panels. The purpose of this was to allow the conference organizers to sort all of the submissions into thematic categories as they emerged organically from the collection of proposed abstracts. The intention was to cluster papers into theoretically coherent “streams” and then breakup those “streams” into panels, thus creating a series of theoretically or topically unique “mini-conferences” that would run concurrently, one panel at a time. In the final schedule, there were 10 such streams of 50 or 60 presentations, each located for the duration of the conference in a different seminar room or small lecture hall at the university. The thematic focuses of these 10 streams included such topics as “The Reconfigurations of Medical Practice,” “New Collectivities in Health,” “Transnational/Transcultural Flow,” and “Gender, Power, and Race,” among others.
Intrigued, I crafted my own submission, knowing that, without a panel abstract and accompanying abstracts from related papers, I had only 250 words with which to situate my work within a diverse terrain of theoretical approaches. I am currently conducting fieldwork in Ukraine. The focus of my current project is the set of social values shaping the treatment-seeking behavior of opiate addicts in methadone therapy programs. I was careful to use specific key words to frame my work, to make sure that my main points of interest and my view of the relevance of my data were made clear. I peppered the abstract with terms like “medicalization,” “narrative,” “pathology,” and “social identity.” I hoped that this would successfully communicate not only what my presentation would be about, in a topical sense, but where my presentation would be coming from, in a theoretical sense.
When I received my notice of acceptance, I was surprised. I had been assigned to a stream entitled “Human Intersections: Violence and Agency.” I found this deeply ironic, as much of my recent musings and writing has focused on how limited the concept of structural violence is when used as a frame for considering the lived realities of addiction in Ukraine. Well, maybe “limited” is the wrong word; it’s obvious that both social marginalization and addiction lend themselves to discussions of structural violence quite easily. This is probably why I was assigned to this stream in the first place: the topic of drug use is low-hanging fruit for a conference organizer who wants to pad a panel on structural violence. Perhaps it would be more accurate to say that I am finding the concept of structural violence incredibly unhelpful, if not a total theoretical dead-end, when attempting to understand and articulate the motivations behind addicted persons’ treatment seeking behaviors here in Ukraine. And yet, I found myself sorted into this conference stream in which ‘violence’ was intended to be the central point of discussion.
I was not the only participant who was surprised by their assignment. As emails filled with conference schedules and logistical information started circulating to the members of my stream, more than a few hit ‘reply all’ and requested clarification. One participant made a comment that mirrored both my surprise as well as my resignation to the fact that my research topic is somehow doomed to always live in this particular theoretical corner: “I am a bit surprised that my presentation was included in a stream about violence and agency, but perhaps that is how the group sees my contribution.” The final schedule for my stream included papers from a broad variety of topics and regions. Presentations elaborated participants’ research on homelessness in Spain and in the US, food safety in China, gender re-assignment surgery in Puerto Rico, and addiction treatment in Morocco, among many other topics.
Part way through the actual conference, after the majority of the scheduled panels had been heard, someone candidly made the observation that “this stream-thing has worked to some degree.” A few mumbles of agreement emerged from around the room. It worked (to some degree) because the participants made it work. Some, myself included, re-designed their presentation entirely to address (and reject) the concept of violence in a more overt way. Others included little addendums at the end of their talk, which outlined what they thought their research had to offer to theories of violence and agency. Tom Leatherman, for example, spoke on themes of hope and vulnerability in the Andes and made reference to the “markers of structural violence” at his field site: poverty, literacy rates, infant mortality, and incidence of infectious disease. Kapil Dahal, who presented work on gender-based violence in Nepal, questioned the meaning of structural violence, by considering ways in which social protections can become forms of exclusion. Anahi Viladrich gave a powerful presentation on the humanitarian failures of US healthcare reform and connected her position to the concept of violence by highlighting the social labels that current healthcare discourse permits. “Our job as scholars,” she said, “is to kill the frames of criminality and the welfare queen.”
Despite the quality of and general level of interest in the work presented, it became clear to most stream participants rather early on that the research topics presented in our stream were so disparate that we were all doomed to be novices in each other’s areas of expertise. (I’ll be honest—I adored Catherine Trundee’s presentation, but I know nothing about the history of nuclear testing on Christmas Island, and consequently had nothing to offer in the subsequent discussion). It also became clear that violence and agency were not themes that could easily connect our work or build out of it a coherent conversation about theory, advocacy, or medical anthropology. We were, in a way, just a group of scholars who had committed to being in a room, sharing our work, and hearing each other out over a period of three days. As counter-intuitive as it may sound, and despite all of the drawbacks that it came with, though, the lack of an obvious thread with which to connect our work was one of the most beneficial aspects of this unique stream format. As a consequence of our structureless collective, a shared insight slowly emerged over the course of the conference, one that likely would have never come into focus if the theme of violence had been able to shape the conversation as intended.
The seed of the discussion that, at least for me, became the definitive, valuable take-away of the conference came out of Sandra Hwang’s paper, “Constructing ‘empowerment’ in the context of HIV prevention interventions for female sex workers in India: exploring the encounters between intervention designers, implementers, and funders.” Much in the spirit of the conference theme, Hwang discussed the discourses of empowerment that emerge when different actors with different agendas meet for the purposes of international development. Following Tom Leatherman’s discussion of the “marks of structural violence” in his earlier paper, Hwang spoke of “marks of empowerment”—the characteristics displayed by an individual who, by the standards of international development projects, has been successfully ‘empowered.’ In her own research, she has seen that the ‘empowerment’ of commercial sex workers often becomes synonymous with a change in the relationship between these women and “powerful [local] stakeholders” like the police. Empowerment also gets used interchangeably with access to services and successful prevention strategies; the implication of this mode of thinking is that sex workers who are empowered will not contract HIV, and contracting HIV is a sign that a sex worker has not been successfully empowered.
The discussion following this panel quickly turned to the ways in which this logic, which many other researchers in the room found familiar and claimed to have observed during the course of their own work in other parts of the world, is extremely problematic on its face. One participant noted, “Empowerment is under-problematized in social science. It’s a concept used by international groups to free the government from the obligation of acting. Health should be framed as a human right, not an issue of empowerment.” A common concern that was shared by many stream members was how best to approach such limited notions of ‘empowerment’ and respond in a way that acknowledges a broader diversity of choices, actions, and forms of agency.
Ellen Foley offered a particularly powerful example of why this sort of anthropological work is needed. In her presentation, entitled “Engaging sex work in Senegal,” she discussed access to health services for women who are involved in ‘transactional sex’ in Senegal. In this context, ‘transactional sex’ is considered an economic strategy rather than a commercial activity. A woman who is having sex with a man who helps pay her rent, for example, is not engaging in commercial sex work as it is commonly understood; however, the sexual relationships that she maintains are an integral part of her economic survival strategy, and her need for medical care and infection prevention strategies may be increased because of them. The trouble lies in the fact that most affordable health services for women with multiple sexual partners in Senegal are designed specifically for commercial sex workers. Therefore, gaining access to available care is contingent upon women taking up the formal identity of a commercial sex worker—an identity that many women engaging in transactional sex will openly reject. After all, if you must choose between protecting your physical wellbeing and protecting your social wellbeing, which choice can really afford you more ‘agency’? Which option poses the greater threat of ‘violence’ towards the women in question? Which course of action would an ‘empowered’ woman choose? Here, it becomes especially clear that a mono-dimensional conceptualization of empowerment can fail significant portions of the population–especially when aid programs consider ‘empowerment’ to be one of their key deliverables.
Over the course of the next two days, this question—how can we contribute to a better approach to empowerment—grew to include a more practical concern that also sat heavy on many participants of the Violence and Agency stream: once we have a key contribution to offer, like a re-conceptualization of ‘empowerment’ or ‘agency,’ how do we reach the right audience? How have anthropologists succeeded in gaining the ear of development groups in the past? How have they failed? Can this be done without putting marginalized communities at risk? Can this be done without alienating a powerful development community that seems to be here to stay, whether we like it or not? No concrete answers to these questions were developed in my stream, but a palpable sense of relief accompanied the act of stating them out loud. It was as though many people in the room had been thinking these very things for quite a while but lacked the common vocabulary to really discuss them with other scholars.
My experience at the EASA/SMA conference was necessarily limited, of course. With the exception of one hour during which I ducked out to see Zane Linde-Ozola present her research on patient safety in Latvia, I remained with my stream for the entire conference, as was clearly the intention of the conference organizers. I heard from various colleagues that other streams had achieved both noticeably greater and noticeably lesser amounts of coherency than my own. For the members of some streams, the thematic clustering of papers really worked and generated an invigorating conference experience; for others, the groupings seemed sort of haphazard and unhelpful. I am satisfied with the impression that my stream seemed to fall somewhere in the middle.
A number of things could have been done to improve the structure and coherency of my stream: language barriers could have been mitigated by asking participants for bi-lingual abstracts or slides; written abstracts or summaries could have been offered to each stream, outlining what the theoretical focus of the stream was meant to be and indicating why each paper was selected as it was would have been a huge help to presenters as we prepared our talks; more frequent opportunities for mingling and networking would have been nice as well, as the scheduled coffee breaks felt a bit disconnected with multiple centers of activity and a large amount of floor space in which to lose the colleagues you had intended to connect with.
Despite these small complaints, I have to admit that I adored the conversation that emerged from my stream, and I honestly believe that any change in the conference format (including those I suggested above) might have stifled it. Because the conference didn’t present us with the firm sort of structure we were used to, we had to generate it on our own. This wasn’t always comfortable—truth be told, my stream suffered a number of awkward moments throughout the conference as we struggled to connect one panel to the next and build a conversation—but in the end, we generated something completely new: a conversation that many of us have been wanting to have but didn’t know whom to have it with.
I cannot say if the stream format used in Tarragona would help or hinder other conferences in the future. It still seems too new, and scholars are clearly still figuring out how to interact with it. The utility of this structure remains to be determined by subsequent conferences and gatherings, as the format (and the participants) gains its sea-legs as an accepted mode of operation. What was clearly demonstrated at the EASA/SMA conference in Tarragona, though, is the value of disrupting our expectations.
Jennifer Carroll is a medical anthropologist who researches gendered identity and drug addiction in the US and in Ukraine. She is currently working towards her Ph.D. in Socio-cultural Anthropology at the University of Washington. She also holds an M.A. in Sociology from Central European University and a B.A. in Anthropology from Reed College. Her early work focused on identity and subjectivity among drug users in Ukrainian harm reduction programs. Currently, through her dissertation research, she seeks illuminate how and why opiate users in Ukraine decide to seek out substitution therapy and adhere to treatment protocols from day to day.
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