Dr. Sung-Joon Park, Bernhard-Nocht-Institute, Hamburg, Germany (Principal Investigator)
Dr. Herbert Muyinda, CHDC, Makerere University, Kampala, Uganda (Principal Investigator)
Dr. Nene Morisho, Pole Institute, Goma DRC (Principal Investigator).
The main objective of this research project is to provide a comparative study of diagnostic testing in the COVID-19 response in Uganda and the Democratic Republic of the Congo (DRC). The project will employ a grounded theory approach to study testing as a technology of knowing. Following this approach, we maintain that studying what people know cannot be separated from a consideration of how they know. Based on this approach, we will examine how COVID-19 testing in the two countries makes both knowing and unknowing—the latter comprising strategic ignorance, public secrets, speculation, and silent knowing—possible. This focus on knowing and unknowing offers an important analytical frame to study people’s assessment of the severity of the pandemic in the two countries and the consequences of knowing and unknowing for people’s health-seeking practices in the context of the pandemic. This research objective is based on the following pressing issues we are observing in the two countries, which our study will address:
(1) We hold that exploring the use of diagnostic testing is fundamental to compare the variety of public health emergency response strategies adopted by countries across the world, to examine public health decision-making based on evidence obtained from testing, and to assess the effectiveness of response strategies. In this respect our study will provide important empirical findings on the role that testing has so far played in the public health responses to COVID-19 in Uganda and the DRC.
(2) Our social scientific study of COVID-19 testing will complement biomedical perspectives on testing by providing an analytical perspective to explore testing as a technology of knowing that makes uncertainties visible (Whyte, Whyte, & Kyaddondo 2018). In the context of the COVID-19 pandemic, testing makes new forms of unknowing visible, which may lead to disagreements about the kind of uncertainties that people and public health authorities are willing to accept, or not (Street & Kelly 2020; see also Alexander & Hare 2020). As anthropologists have argued, this notion of unknowing should not be taken as the opposite of knowing. Unknowing comprises strategic ignorance (McGoey 2012; Dilley & Kirsch 2015), public secrets (Taussig 1990), speculation (Wilkie, Savransky, & Rosengarten 2017), and silent forms of knowing, especially in the science and politics of epidemics (Geissler 2013; Park 2021). This is particularly crucial in the case of COVID-19. People in both Uganda and the DRC are not lacking knowledge about the disease—a frequent source of misunderstanding in public health responses. Instead, people are confronted with many unknowns reflecting the epidemiological, political, economic, and social uncertainties produced by the emergency responses in the two countries. Exploring the unknowns in the pandemic is thus crucial to grasp people’s assessment of the severity of the pandemic and the level of trust in the public health response (Morisho et al. 2020).
(3) Our social scientific study on testing will engage with a pressing question in both the DRC and Uganda: ‘How severe is COVID-19?’ Official statistics do not provide a clear answer. According to official reports, the numbers of confirmed cases, severe illnesses, and deaths suggest that the pandemic has been less severe in both countries, contrary to many predictions that COVID-19 would have a devastating impact on African countries. The latest WHO reports state a total of 39,900 confirmed cases and 328 deaths for Uganda, and 23,899 confirmed cases and 685 deaths for the DRC. The reasons are, however, unknown. Possible theories relate to age structure, acquired immunity, climate, lessons learnt from Ebola epidemics, and harsh lockdown measures (Mbow et al. 2020). More importantly, it could be an effect of under-testing, with a significant number of unreported cases and deaths. Indeed, testing is not free in either country—the price for a test ranges from USD 40-70—which is not affordable for the majority of the population. Thus, official statistics are heavily skewed toward those who can afford tests or who were required to test (e.g., international travelers). Additionally, both countries were early to impose harsh lockdowns, which disproportionately affected the poor (Epstein [forth.]; Kinyera & Doevenspeck [forth.]). The discrepancies between what is known and the less visible consequences of these measures have to be taken into account when studying people’s trust in or mistrust of official statistics and the public health responses. For instance, expensive testing has given rise to the public perception that COVID-19 is a disease of the ‘rich people’; or more seriously that the response is not about infectious disease control but a ‘business’ and is politically instrumentalized. Studying trust and mistrust is particularly crucial in relation to the expected introduction of vaccines and the cheaper rapid diagnostic tests, both of which will be crucial in the response to more severe waves of COVID-19 that might emerge (Richards & Cohen 2020).
(4) Finally, our study has the ambition to make an important scholarly contribution to social scientific studies of testing in African countries and to contribute to the improvement of the response to COVID-19. COVID-19 tests differ in particular ways from other testing technologies that have been extensively studied on the African continent, including for HIV, Ebola, and non-communicable diseases. Our study aims to explore the consequences of unknowing and knowing for people’s health-seeking behavior in the context of COVID-19. We will explore how people notice and determine community transmission when tests are not available, how people and their families seek care and treatment for severe illnesses, and moreover how they confront death in times of COVID-19 (see also Muyinda & Mugisha 2015; Muyinda 2020). Our investigation of these questions and the theoretical contribution we expect to make will be an important basis for developing a long-term research project on preparedness for future epidemics in the region.
Alexander, Catherine, and Patrick O’Hare. 2020. “Waste and Its Disguises: Technologies of (Un)Knowing.” Ethnos 1–25.
Charmaz, Kathy. 2006. Constructing Grounded Theory. Pine Forge Press.
Clarke, Adele. 2005. Situational Analysis : Grounded Theory After the Postmodern Turn. Thousand Oaks, Calif.: Sage Publications.
Clarke, Adele E., Carrie. Friese, and Rachel Washburn, eds. 2015. Situational Analysis in Practice : Mapping Research With Grounded Theory. Walnut Creek: Left Coast Press, Inc.
Dilger, Hansjörg, and Sung-Joon Park. 2020. “Anthropological Perspectives in Health Emergencies.” In In Control: A Practical Handbook for Professionals Working in Health Emergencies Internationally, edited by Silva Lauffer, and Jonathan Walter, 154–64. Berlin: RKI.
Epstein, Helen. [draft]. “A closer look at Uganda’s COVID-19 response.” American Journal of Public Health
Geissler, P. W. 2013. “Public secrets in public health: Knowing not to know while making scientific knowledge.” American Ethnologist 40 (1): 13–34.
Glaser, Barney G., and Anselm L. Strauss. 1967. The Discovery of Grounded Theory. Transaction Publishers.
Dilley, Roy, and Thomas Kirsch, eds. 2015. Regimes of Ignorance: Anthropological Perspectives on the Production and Reproduction of Non-Knowledge. New York: Berghahn Books.
Park, Sung-Joon, Nene Morisho, Kennedy Wema Muhindo, Julienne Anoko, Nina Gobat, Hannah Brown and Matthias Borchert. 2020. “What do adaptations tell us about the production of trust? Shifting the ‘burden of change’ from people to the response.” Humanitarian Exchange: Special feature, Responding to Ebola in the Democratic Republic of Congo 22: 24–26.
Kinyera, Paddy, and Martin Doevenspeck. [forth.]. “Covid-19 and the Politics of (Im)mobility in Uganda.” In Covid-19 in Africa: Perspectives on Politics, Society and Culture, edited by Susan Arndt, Yacouba Banhoro, Taibat Lawanson, Enocent Msindo, and Peter Simatei.
Mbow, M, B Lell, SP Jochems, B Cisse, S Mboup, BG Dewals, A Jaye, A Dieye, and M Yazdanbakhsh. 2020. “COVID-19 in Africa: Dampening the storm.” Science 369 (6504): 624–26.
McGoey, Linsey. 2012. “The logic of strategic ignorance.” Br J Sociol 63 (3): 553–76.
Muyinda, H, and J Mugisha. 2015. “Stock-outs, uncertainty and improvisation in access to healthcare in war-torn Northern Uganda.” Soc Sci Med 146 316–23.
Muyinda, Herbert. 2020. “The Skilling Journey.” Current Anthropology 61 (S21): S123–31.
Morisho, Nene, Josepha Kalubi, Sung-Joon Park, and Martin Doevenspeck. 2020. “Same but Different? A Comparison of Ebola Virus Disease and Covid-19 After the Ebola Epidemic in Eastern DRC (2018–20).” African Arguments https://africanarguments.org/2020/04/24/same-but-different-a-comparison-of-ebola-virus-disease-and-covid-19-after-the-ebola-epidemic-in-eastern-drc-2018-20/
Park, Sung-Joon. 2021. “Deadly secret: Situating the unknowing and knowing of the source of the Ebola epidemic in Northern Uganda.” Journal of the Royal Anthropological Institute
Richards, Paul, and Daniel Cohen. 2020. “Covid-19 in Africa: What if there Is a Second Wave?” African Arguments [https://africanarguments.org/2020/11/covid-19-in-africa-what-if-there-is-a-second-wave/]
Street, Alice, and Anne Kelly. 2020. “Counting coronavirus: delivering diagnostic certainty in a global emergency.” Somatosphere [http://somatosphere.net/forumpost/counting-coronavirus-diagnostic-certainty-global-emergency/]
Taussig, Michael. 1990. Defacement: Public Secrets and the Labor of the Negative. Stanford: Stanford University Press.
Whyte, Susan Reynolds, Michael Whyte, and David Kyaddondo. 2018. “Technologies of inquiry: HIV tests and divination.” HAU: Journal of Ethnographic Theory 8 (1-2): 97–108.
Wilkie, Alex, Martin Savransky, and Marsha Rosengarten. 2017. Speculative Research : The Lure of Possible Futures. London; New York: Routledge Taylor & Francis Group.