Six years after the event there is a consensus among TB/HIV researchers and clinicians that the announcement of XDR-TB was a crucial moment in the fight against TB/HIV in South Africa and elsewhere, leading to increased international and local funding and interest in combating tuberculosis. For my PhD dissertation in the History and Sociology of Science, I have been studying events that led up this moment, and how the story of XDR-TB has played out since then. I have spent the past year in KwaZulu Natal investigating the South African side of XDR-TB. As part of this work, I have been living in Tugela Ferry for the past eight months, working on an ethnography of the TB program at Tugela Ferry’s Church of Scotland Hospital (COSH), and of the research programs of Philanjalo, an NGO affiliated with COSH. The excitement and cutting edge nature of XDR-TB is clear from many of the interviews I have conducted with US and South African researchers who were involved in uncovering and explaining Tugela Ferry’s outbreak. From the American perspective, the research in Tugela Ferry became an exciting example of the rising field of “global health.” Dr. Neel Gandhi (with whom I opened this article) and others have been building promising careers around their research on TB in South Africa. A succession of international (mostly American) medical students and physicians has come through Tugela Ferry and Durban to work on HIV/TB. Even six years later, there is still plenty of innovative and stimulating work to be done; though activities have moved from trying to determine “what happened” to understanding “what to do about it” and expanding the knowledge gained in Tugela Ferry to the rest of the province and the rest of South Africa. In this paper, I now turn away from these international visitors to consider what “global health” looks like from a local perspective. Specifically, I look closely at the TB office at the Church of Scotland Hospital and consider the engagement of two groups of staff: injection nurses and tracer teams. Their activities are essential to the management of drug-resistant TB (and thus the global health enterprise), yet these workers do not directly receive the advantages of being included in a global endeavor.
Dwyer2011.pdf