Duke University Press, 2018. 224 pages.
In Edges of Exposure, Noémi Tousignant provides a comprehensive and provocative history of the “slow starts” in the attempts to build a robust, public infrastructure for monitoring toxins and their very real human impact in postcolonial Senegal. She traces the ways that Senegalese toxicologists and their colleagues have chased the promises of a “public science” and its ability to protect the Senegalese population from potential dangers, while the funding and political will to construct and maintain regulatory capacity have appeared, disappeared, and reappeared along the way. Like Ramah McKay and Crystal Biruk – as well as Julie Livingston, Claire Wendland, and other medical anthropologists and historians before them – Tousignant chronicles the “improvisations of capacity” among those working to secure the health of the public in conditions of scarcity and unfinished capacity building in postcolonial Africa.
Tousignant presents these improvisations in three different spaces of toxicological capacity building in Senegal – the academic toxicology and analytical chemistry laboratory at the public Cheikh Anta Diop University (UCAD), the laboratory of a transnational partnership called Project Locustox, and the recently “hast[il]y routiniz[ed]” government-sponsored Centre Anti-Poison (CAP). In the first two chapters she shows how the vestiges of the French period of la coopération after Senegal’s independence from 1960 until the 1980s – in the “wreckage” of aged and left-over equipment (Chapter 1) and the living memory of those who were in the lab during this time (Chapter 2) – are reminders of an imagined future in which such a French-Senegalese partnership would have “jump-started” a postcolonial state-supported regular monitoring system of toxins. The 1980s in Senegal were characterized by crisis and austerity, similar to much of Sub-Saharan Africa. With the end of la coopération and the establishment of structural adjustment packages by the International Monetary Fund and the World Bank, along with prolonged drought and diminishing markets for Senegal’s agricultural products, state support of public institutions decreased dramatically. In the third Chapter, Tousignant describes how from the 1980s until the 2000s, toxicologists in UCAD’s academic lab produced more of a “regulatory fiction” than an effective regulation of poisons, stretching “left-over” capacity from past international partnerships by performing tests intermittently when funding for reagents or for shipping blood samples from their “frozen archive” was secured through international partnerships.
Provided as an exceptional case of promoting a durable and protective African science, Project Locustox was a project initially funded in the 1980s by the Netherlands and the Food and Agriculture Organization to monitor the effects of locust outbreaks and their pesticidal control in the Sahel (Chapter 4). However, this project was “semiprivatized” in 1999, becoming an institution that mainly traces toxins in Senegalese exports, leaving open the gap, again, for a public toxicological institution. It was into this space that Alassane Diagne, Amadou Diouf, and others reanimated the dream of producing a public Centre Anti-Poison as an extension of a state that cares for its citizenry (Chapter 5). This was part of a larger pattern, under President Abdoulaye Wade in the early 21st century, of the “return” of the state that performed emergence through promises – sometimes empty and sometimes fulfilled – of strengthening Senegalese infrastructure.
Toxicological regulation in Senegal since 1960 is characterized by what Tousignant calls “unprotection,” describing the incompleteness and inability to protect in a systematic way as defined precisely by the “loss of what once was and/or is acknowledged to be possible” (2018: 16). Longing for an African toxicology that “might have been” had there been sufficient government or global health donor support, Senegalese scientists have managed with “capacity-bridging” equipment (like the single or limited range toxin-testing machines Minilab and LeadCare II) and inconsistent project funding to keep the chassis of potential regulation moving forward. In the current moment, they wait for sufficient infrastructure, equipment, and reagents for robust poison regulation, as they “perform” the state “in the meantime,” to use McKay’s (2018) phrase. That waiting is indicative of how these toxicologists define “good” science – their work continues to be fueled by aspirations for the government to provide and sustain these institutions for the betterment of Senegalese society as a whole.
What does it mean to produce and maintain institutions that are an extension and presence of a state that cares? One of Tousignant’s goals is to show how the dream of protecting Senegalese citizens from poisons is much older than a reaction to the tragedy of lead poisoning in the community of Ngagne Diaw that left eighteen children dead and hundreds sick in 2008. The fact that this is an “unprotective” system obscures more than fifty years of work on the part of Senegalese toxicologists, in partnership with state and international partners, to advocate for regulation, find funding for routine and intermittent toxin testing, procure support for graduate students, acquire equipment, and so on. Using these toxicologists’ “partial privilege” as a point of departure – these are not the most vulnerable members of Senegalese society and yet they experience precarity in very real ways because of incomplete state infrastructure – Tousignant highlights the global disparities between those of “us who live in only somewhat dismantled welfare states” (148) and those who live in states that have merely aspired to provide welfare. What can we demand from the state and from science in this space of incompletion, and how is that incompletion exacerbated by the privatization and projectification of health that currently defines global health development?
Taken with Biruk’s ethnography of health data collectors in Malawi and McKay’s of non-governmental care in Mozambique, Edges of Exposure also drives home the starkness of our uneven global economy of health. In the promotion of privatized approaches to healthcare and scientific capacity for health, the entities that govern and fund global health development – like the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the World Bank – continue to exacerbate this precarity and incomplete capacity in the name of short-term achievable goals. In the midst of the demands that these entities make on recipients of research-as-healthcare projects, which include extensive data about performance used to prove the effectiveness of the model, the constitution of “good science” and health are shaped by the temporality and limitations of grant funding. Tousignant offers a much-needed ethnography of the ways that scientists can perform an emerging state, coupled with an in-depth exploration of the ramifications therein, and leaves us with the fundamental question of how to address global inequities that demand such precarious performances.
Marlee Tichenor is a Postdoctoral Research Fellow with the Global Health Governance Programme at the University of Edinburgh. As a medical anthropologist interested in the politics of evidence and data in global health policy and intervention, she is currently studying the development of metrics at the World Bank for measuring success, along with the Bank’s impact on conceptions and implementation of universal health coverage in global health discourse and in Senegal. She received her PhD from UC Berkeley and UC San Francisco, and she is currently revising her dissertation into a manuscript entitled Malarial Proximities: Ordering Illness and Global Health Discourses in Senegal.