Chapter 10

Anthropology and Medical Humanitarianism

in the Age of Global Health Education

Peter Locke

As ‘‘global health’’ is consolidated as an interdisciplinary field of inquiry

and intervention, flush with new money and motivation to address dispari-
ties in disease burden and inadequate or ailing health systems, mental
health researchers and professionals have been working to advocate for the
importance of what they have taken to calling ‘‘global mental health,’’
drawing on burden of disease data grounded in the controversial disability-
adjusted life years (DALYs) metric to argue that mental illness constitutes
a ‘‘hidden epidemic’’ in poor countries (Becker et al. 2013, Prince et al.
2007, Miller 2012, Koplan et al. 2009). This burgeoning subfield is animated
by intense debate between psychiatric epidemiologists-turned-advocates
like Vikram Patel who argue that, in general, Western and international
diagnostic frameworks for mental illness can and should be applied across
cultures and contexts, and provocative social critics like psychiatrist Derek
Summerfield who characterize mental health efforts in the postcolonial
countries of the Global South as a kind of ‘‘medical imperialism’’ (Bemme
and D’souza 2012, Summerfield 2008).
Anthropologists of health and humanitarianism, for their part, have
both critiqued the discourse, assumptions, and practices of humanitarian
psychiatry and related international mental health interventions (Fassin and
Rechtman 2009, Pandolfi 2010, cf. Pupavac 2010) and engaged directly in
assessing mental health needs and working to scale up and destigmatize
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194 Locke

mental health care in underserved areas—as in the work of Harvard Uni-

versity faculty Byron Good and Mary-Jo DelVecchio Good in collaboration
with the International Organization for Migration (IOM) in Aceh in the
wake of conflict and natural disaster there (2010). These two lines of
engagement with global mental health research and intervention—the one
an exercise in critical social analysis, the other a project of applied expertise
and advocacy—seem also to be indicative of the currently prevailing alter-
natives for anthropological scholarship in and about the booming field of
global health in general. As charismatic figures like Paul Farmer and Jim
Kim and academic communities like Harvard’s Department of Global
Health and Social Medicine carved out an unabashedly activist medical
anthropology in the 1990s and 2000s that engaged directly in medical
humanitarian projects, institution-building, and broader health policy
debates, anthropologists like Didier Fassin and Mariella Pandolfi were
developing what has become an influential and sweeping critique of mod-
ern humanitarianism—inclusive of the world of global health interventions—
as a form of mobile biopolitical sovereignty deeply complicit with the
expansion and consolidation of a neoliberal world order (Fassin 2012, Fas-
sin and Pandolfi 2010).
Meanwhile, new global health centers, programs, and institutes have
been growing rapidly at universities across the United States to engage
a new generation of students driven both to understand international
health disparities and to do something significant about them—a gen-
eration examined with deep critical insight, for example, in physician-
anthropologist Claire Wendland’s recent work on ‘‘clinical tourism’’ at
Malawi’s medical school (2012). The demand among medical students
(and, I would add, undergraduates) for ‘‘global health experiences’’ has
exploded so quickly that universities are struggling to keep up, often brack-
eting thorny questions about the equity of new international partnerships
along the way (Crane 2013). This trend, Wendland notes, is ‘‘only one
manifestation of a larger push for service-learning projects in poor places
that blur easy distinctions between humanitarian action, educational expe-
rience, and adventure travel’’ (2012: 110). This ‘‘push for service-learning’’
is situated in and shaped by a longer history of what Wendland calls ‘‘moral
pilgrimages’’ by elite Western students, in the contexts of, for example, the
missionary medicine of the eighteenth and nineteenth centuries and the
colonial public health apparatuses of the late nineteenth and early twentieth
centuries.
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 Sierra Leone: Global Health Education 195

In this chapter, I describe my efforts to understand these trends and trans-

formations together—the growth and consolidation of global health and
global mental health as fields of research and intervention, along with the
boom in student engagement and interest—within the same frame and
fieldwork project. I am beginning to study a small, precariously funded medi-
cal humanitarian organization that I call ‘‘Global Alliance for Health’’ operat-
ing in a rural area of postwar Sierra Leone, exploring the intervention’s
entanglement with and impact on multiple domains of medicine and care-
giving, from mental illness and food security to HIV/AIDS, traditional
healing networks, and maternal and child health. At the behest and encour-
agement of the global health education program that employs me at the time
of this writing, I am including small groups of undergraduate global health
students in my summer trips to the field and engaging them in collaborative
field research according to their disciplinary backgrounds and interests,
attempting to harness anthropology to enhance experiential learning and
develop reflexivity and critical thinking skills in future global health leaders.
I now turn to a brief history of Global Alliance for Health, focusing
particularly on their recent foray into basic psychiatric care to consider a
few of the moral dilemmas and tensions generated by the convergence of
global mental health agendas, medical humanitarianism, and the evolving
forms of transnational movement through global health education in which
I have become immersed. As this convergence indicates, both analytical and
empirical boundaries around the categories at hand—‘‘global health’’ and
‘‘medical humanitarianism’’ especially—are blurry, and a vital contribution
of ethnographic work may be to demonstrate how they serve as overlapping
or floating signifiers that allow actors in the field, including both research-
ers and practitioners, to frame and justify their projects. The chapter high-
lights the difficulties of carefully bounding the anthropologist’s and the
students’ roles amid these blurring categories of engagement and vis-à-vis
an improvised partnership with an institution governed—like the field of
‘‘global health’’ more generally—by a powerful sense of moral urgency and
humanitarian emergency. I suggest that what sociologist Craig Calhoun has
called the ‘‘emergency imaginary’’ of contemporary humanitarianism
(2010) is converging with a range of transnational resource flows, institu-
tional collaborations and engagements, and the powerful example set by
figures like Paul Farmer to create the conditions of possibility for new,
multiplying forms of small-scale experimentation with healthcare delivery
in resource-poor settings.
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196 Locke

Global Alliance for Health

Global Alliance for Health defines itself as a medical humanitarian organi-

zation guided by the belief that ‘‘healthcare is a human right.’’ It was
cofounded in the mid-2000s by an American physician, at that time in his
mid-twenties and working toward his MD; a few of his family members
and supporters in the United States; and a Sierra Leonean doctor who had
just completed his studies at the medical school in Freetown. The American
physician, whom I’ll call Jeff, had taken advantage of a global health fellow-
ship offered by his university to visit and spend short periods of time work-
ing in clinics and hospitals in several locations in sub-Saharan Africa. The
conditions in Sierra Leone, burdened by deep and widespread poverty and
still gravely impacted by the war of the 1990s, struck him as the most dire
he had seen: very limited public health infrastructure, goods, and services
outside of major population centers and maternal and infant mortality rates
that continue to rank among the highest in the world. Through connections
Jeff met the Sierra Leonean doctor with whom he would partner (I’ll call
him Tamba), and they initiated an intense—and sometimes turbulent—
friendship grounded in what they each perceived to be a shared commit-
ment to provide quality healthcare to Sierra Leone’s worst off.
In their assessment, this turned out to be the country’s many am-
putees—people who had had fingers, hands, and/or entire limbs cut off
by Revolutionary United Front (RUF) forces during the war—along with
their dependents (Berghs 2010). A few hundred amputees and their families
had been resettled near the capital of a rural district in very basic homes
in what are locally called ‘‘amputee camps,’’ constructed and occasionally
maintained by a Scandinavian aid organization not long after the war
ended. Very few of the amputees had paying work of any kind, often
because of their diminished capacity to do manual labor as a result of their
injuries, and were scraping by on small-scale subsistence gardening, street
begging, and dwindling food aid from organizations like World Vision.
Because workers at the woefully understaffed and under-resourced local
government hospital regularly charged prohibitively high user fees for treat-
ment and often required patients to find and purchase any drugs they
needed from local private pharmacies, the amputees and their families—
nearly penniless and consumed each day with figuring out where their next
meal would come from—essentially had no access to medical care.

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 Sierra Leone: Global Health Education 197

Jeff and Tamba decided to build a small clinic near the camps to serve
the amputees and their families. Global Alliance for Health was officially
registered, and Jeff’s family members and supporters in the United States
contributed the necessary funds to build and equip the first basic clinic
structure. Tamba staffed the operation with Sierra Leonean nurses and lab
technicians he knew from large international nongovernmental organiza-
tion (NGO) projects he had worked on and stocked their small pharmacy
with inexpensive Indian generics he or one of his employees purchased
periodically in Freetown. The clinic has provided care to all amputees and
their family members for free and over time has extended its services to a
much wider range of people by charging small fees for those who can afford
to pay and through unsystematic fund-raising in the United States. In the
process, Global Alliance has effectively become the main provider of safe
and affordable basic medical care in a district with no more than three
doctors for about six hundred thousand people and where government
health facilities experience chronic shortages of essential drugs and other
supplies. Dozens of individuals and families from surrounding villages
begin lining up as early as 4 a.m. each day to await the clinic’s opening,
hoping for the chance to consult a nurse—each of whom sees forty to fifty
patients a day—about ailments ranging from the ubiquitous malaria and
parasite infections to more complex problems that likely have little chance
of successful treatment within the district—or anywhere in the country.
Since the beginning, the organization—in its early days run essentially
only by Jeff and Tamba, with ad hoc support from friends, family, and
colleagues—has struggled to raise money, build capacity, and expand its
services. It has often been troubled by tensions over guiding priorities.
Research is arguably more highly regarded than clinical care in Western
academic medicine’s hierarchy of worthy professional engagements, and
Jeff has to varying degrees embodied and applied this hierarchy in his
efforts in Sierra Leone. While early on Jeff and Tamba had focused their
efforts on clinical capacity, more recently Jeff has searched for ways to
implement randomized studies that could demonstrate efficacy to donors
and further his own research aspirations. Tamba, who grew up in deep
poverty and experienced considerable hardship and loss on his road to a
medical education during Sierra Leone’s civil war, is passionate about
ideas of social justice and serving the poor—following Jeff’s recommen-
dation, he has been devouring Paul Farmer’s books and is considering

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198 Locke

graduate school in medical anthropology—and sometimes bristles at

Jeff’s interest in mobilizing clinic patients as experimental subjects for
health research. Indeed, their relationship seems to have become more
fraught with time, as Jeff has proceeded with a range of well-intended
studies and initiatives without, Tamba feels, adequately eliciting or
respecting his local knowledge.
Not surprisingly, many of Jeff’s projects end up causing controversy
among Tamba, clinic staff, and patients, as well as raising concern among
supporters in America. Here the dilemmas and ethical conundrums posed
by the ascendancy of ‘‘evidence-based medicine’’ as a model for public
health research and intervention play out in the ups and downs of a friend-
ship, with real consequences and side effects for the people Jeff and Tamba
are working to serve. In Jeff’s world, randomized controlled trials (RCTs)
have become the ‘‘gold standard’’ for research, and investigators are under
intense pressure to conform to it. As medical anthropologist Vincanne
Adams argues (2013a), the growing dominance of RCTs for program evalu-
ation in the worlds of global health and development may profoundly nar-
row the range of evidence that may be considered—and hence of the critical
thinking that may be pursued—in the consideration of global health initia-
tives and triggers a proliferation of hard-to-resolve tensions between the
often dueling imperatives of service delivery and the production of ‘‘rigor-
ous’’ statistical evidence.
In Jeff’s view, his arguments with Tamba have been driven by the lat-
ter’s limited awareness of the ‘‘benefits of research.’’ In a recent conversa-
tion, Jeff emphasized that since beginning a public health degree in the
United States, Tamba ‘‘now understands the type of research more’’ and
the disagreements between them have ‘‘disappeared.’’ The fact that this
rapprochement has been mediated by American public health education,
however, may underscore the importance of the original tensions as symp-
tomatic of broader debates over international hierarchies of expertise and
evidence production in global health today.

Where There Is No Psychiatrist

In an organization as small and as fragile as Global Alliance, the vicissitudes

of personalities and interpersonal relationships seem to take on an outsized
importance and dramatic force, embroiling everyone in the NGO’s orbit
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 Sierra Leone: Global Health Education 199

in the production and management of conflict and moral dilemmas

anchored in differing assumptions about epistemology and care, that is, by
what methods the needs of local people are to be assessed and addressed
and by whom. These dynamics were in full force during a small controversy
provoked by Jeff’s attempt to implement a ‘‘pilot community psychiatry
program’’ based at the clinic. Very few effective and humane psychiatric
services are available in Sierra Leone, and in the region where Global Alli-
ance works, people who show signs of psychosis often suffer from stigma
and poor living conditions. Hoping to begin to address this situation, to
impress potential supporters interested in mental health, and in part
inspired by Vikram Patel’s book Where There Is No Psychiatrist: A Mental
Health Care Manual (2002)—which provides guidance on the provision of
basic mental health care by community health workers in areas without
trained mental health professionals or formal psychiatric services—Jeff
decided that the Global Alliance clinic should implement a mental health
program of its own, even as it continually struggled to shore up its most
basic medical services and resources. Jeff had had some interaction with
traditional healers known for treating instances of what was locally referred
to as ‘‘madness’’ or ‘‘kraze’’ and was dismayed to discover that their meth-
ods commonly included chaining patients by the legs to trees or heavy logs
for extended periods of time. He became convinced that providing basic
psychiatric care could be as morally and medically urgent—a ‘‘humanitar-
ian emergency’’ in its own right—as the other services delivered by the
clinic.
A clinic neighbor who worked as a faith-healing pastor encouraged Jeff
to construct a simple shelter for mentally ill patients as a ‘‘locally appro-
priate’’ setting where they could consult with and be treated by both clinic
staff and the local traditional healers with whom Global Alliance hoped to
partner. With Tamba’s agreement, Jeff constructed a makeshift structure
containing a few basic beds that he called a ‘‘mental health stabilization
center’’ next to the main clinic building using blue tarps and bamboo poles
and spread the word around town and over the radio that Global Alliance
was looking to help people with mental problems and/or seizures. He
brought a stock of generic versions of the antipsychotic Haldol (haloperidol)
and the anticonvulsant and mood stabilizer carbamazepine to the clinic. A
psychiatrist practicing in the United States who had grown up in and emi-
grated from Sierra Leone visited the site for a few weeks with Jeff and
advised him in his initial encounters with mental health patients. When she
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200 Locke

returned home, Jeff continued to consult by phone with psychiatrists and

psychiatry residents in his professional network. He diagnosed at least two
dozen cases of schizophrenia and as many of epilepsy and prescribed trial
courses of haloperidol for the former and carbamazepine for the latter.
Global Alliance’s friends and supporters in America—including me and
the students who had spent time in Sierra Leone—worried a little about
the speed of the development and implementation of Jeff’s psychiatric
intervention. We were partly reassured by his consultations with mental
health professionals in the United States but wondered whether he should
reach out to transcultural psychiatrists to discuss the risks and special chal-
lenges of prescribing psychopharmaceutical treatment for people living in
extreme poverty in a place like Sierra Leone. Soon other questions began
to simmer. Did Global Alliance really have the capacity to support and
sustain patients taking antipsychotics and to manage side effects as they
arose? Did Jeff have plans to make a formal study out of the program? Were
conditions in the tarp structure safe or even humane, and how long were
patients staying there?
In this as in most of his other projects, Jeff’s approach to addressing
health inequalities is primarily pharmaceutical, using medicines not nor-
mally available to Sierra Leone’s rural poor to cure easily treatable diseases
and mitigate chronic symptoms while understanding the broader social
determinants of health to be mostly beyond the realm of his expertise and
responsibility. How would the impact of his mental health work be shaped
by the fact that Jeff did not (and likely could not, given the limited resources
at his disposal) incorporate much in the way of counseling, education, or
forms of regular social and economic support into his approach? Attempts
to partner with a local U.S.-funded psychosocial support NGO had seemed
to fizzle. Finally, we wondered how the program compared to the regula-
tion and oversight of psychiatric diagnosis and psychopharmaceutical treat-
ment in primary care settings in the United States and other rich countries.
While American primary care physicians are indeed trained to treat general
mental health concerns while referring special cases to psychiatrists, it
seemed important to ask whether Jeff’s project might also exemplify an
evolving trend of well-intentioned medical students and young doctors
using ‘‘global health’’ engagements to try out forms of medical treatment
that would be more carefully supervised in their countries of origin. Wend-
land, for example, notes how some of the visiting Western physicians and

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 Sierra Leone: Global Health Education 201

medical students she observed in Malawi’s teaching hospital ‘‘cherry-picked

procedures of interest, those they would never see—or be allowed to do—at
home’’ (2012: 111).
Students and others in the United States voiced these basic concerns to
both Jeff and Tamba. Some of the email exchanges about the program
became angry and heated, I’m told, which often happened when differences
of opinion arose about Global Alliance initiatives. All parties were especially
concerned that the clinic might lack the capacity to provide patients the
full support they would need to benefit from the medications and manage
side effects. In the end, Tamba and Jeff agreed that no new mental health
patients should be taken on, while allowing those who had been prescribed
medications and seemed to be benefiting from them to continue the course
of treatment. The tarp structure was vacated and eventually dismantled.

Local Landscapes of Health and Care

In the meantime, the work I did with students over two months in Sierra
Leone during the summer that immediately followed the end of the psychi-
atric program has helped build a basic understanding of how mental illness
is situated in a broader sociocultural landscape of care and survival strate-
gies. For example, while Jeff and Tamba knew that ‘‘traditional healers’’
were present and commonly enough consulted in the district and that tradi-
tional birth attendants were being actively incorporated into a new and
ambitious maternal and child health program, one student—employing
good anthropological techniques of snowballing interviews and accompa-
nying patients in their therapeutic itineraries—encountered an organized
union, complete with a governing board, chairman, downtown headquar-
ters, and a range of official documents and rules, that claimed a member-
ship of approximately four hundred such caregivers in the region. The
chairman maintained that the healers practiced a range of specializations
and were enmeshed in a network of referrals that brought them into collab-
oration with biomedically trained nurses and community health workers at
small government clinics known as peripheral health units. Visits to healers
at their homes (where they generally practiced) showed that the actual
degree to which they interacted with and held themselves accountable to

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202 Locke

the union varied; but more important, the discovery of the union and sub-
sequent encounters with traditional healers reminded us of the diversity of
local healing practices and how heavily people in the region respected and
relied on them.
Any global mental health paradigm of research and intervention would
likely benefit a great deal from understanding and engaging such diverse
strategies of caregiving and care-seeking—which have a very long history
in sub-Saharan Africa and scholarship about it (Vaughan 1994, cf. Lang-
wick 2008, Igreja, Dias-Lambranca, and Richters 2008)—asking, as we are
encouraging our students to do, what the range of approaches to health
engaged by target communities is offering over and beyond the medical
technologies and pills of encroaching biomedical systems.
We also tried to follow up with many of the patients the clinic had
treated with antipsychotics or anticonvulsants. For those diagnosed and
treated for schizophrenia, it was hard to gauge the impact of such brief
courses of treatment with haloperidol; some families enthusiastically
reported reduced symptoms and better social functioning, while others
seemed less interested in the specific effects of pills and more hopeful that
the pharmaceutical intervention foreshadowed new possibilities on the
horizon for a sustained relationship of aid and care with an organization
like Global Alliance. For the epileptics we met, on the other hand, the treat-
ment was—almost without exception—significantly and positively life
altering. The benefits of anticonvulsants were amplified in the context of a
local universe of meaning in which seizures are often heavily stigmatized as
a form of madness resulting from demon possession or witchcraft, leading
to abuse and ostracism. With the elimination of one young man’s seizure
activity, for example, opportunities for mobility and care that had long
been denied to him—schooling, work, romantic relationships—suddenly
opened up. This and similar cases convinced us that, despite aspects of the
program that had initially worried us and the complexities of translating
psychiatric diagnostics across cultures, our anthropological critique had to
be carefully balanced with constructive dialogue about how mental health
services—including psychopharmaceuticals—could be responsibly inte-
grated into medical humanitarian projects in places like Sierra Leone (see
Good 2011).

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 Sierra Leone: Global Health Education 203

Conclusion

In opening up these realities for Global Alliance, the anthropological work

and thinking of the American students has revealed new possibilities of
intervention and collaboration, even if they offer no easy or quick techni-
cal fix for addressing mental illness. Many global health scholars and prac-
titioners have witnessed or been directly a part of such tinkering with
initiatives, partnerships, and forms of community engagement around
health. For me, our work with Global Alliance in Sierra Leone is raising
large questions about who sets the parameters and monitors accountabil-
ity for these emergent processes and collaborations and how authority is
to be distributed among different professional roles and forms of exper-
tise. As Wendland found in her study of Malawi’s medical school, encoun-
ters between rich-country medical students on ‘‘global health electives’’
and local medical students can trigger profound soul-searching about the
nature of medical caregiving and its translatability across health systems,
culturally diverse understandings and experiences of illness, and immense
resource inequities. At the Global Alliance clinic in Sierra Leone, the
interplay between Jeff’s biomedical training and research methodologies,
Tamba’s local knowledge, visiting students’ research projects and moral
passions, and the plurality of local approaches to health and healing gen-
erates both conflict and creativity and unsettles international hierarchies
of expertise.
The picture becomes all the more complex when we recognize the ways
in which global health education initiatives inevitably and more or less
ambivalently become a part of the phenomena they study. As medical
anthropologists and other health scholars engage with this rapidly expand-
ing and evolving landscape of global health research and services, how are
we to juggle the often conflicting roles of expert consultant—asked, like
the Goods in Aceh, to harness social scientific methods to the design and
authorization of new and ambitious public health interventions—and more
distanced social critic, concerned, like Fassin and others of similar orienta-
tion, to probe contemporary medical humanitarian discourse for its
unstated assumptions and complicities with power and to situate ‘‘global
health’’ in a longer and profoundly mixed history of racialized missionary
and colonial medicine? Is there a path to be charted between these poles? In
this we can look for inspiration, at least, to recent ethnographic work that

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204 Locke

aims to bring the complicated, unfolding, on-the-ground realities generated

by public health, medical, and disaster recovery interventions—and espe-
cially the perspectives and critiques of ‘‘target communities’’—directly to
bear on concrete questions of politics, pharmaceuticals and medical tech-
nologies, and caregiving at local, national, and global scales (Biehl and
Petryna 2013, Biehl 2007, Adams 2013b, Garcia 2010). Indeed, as Jeff and
Tamba continually called on the students and me to consider disputes big
and small over research methods and modes of care delivery, the lines
between critical social scientific distance and direct support to interventions
in-the-making were constantly blurring.
As numerous small-scale community health NGOs are built by a new
generation of students inspired by university global health programs and
by charismatic public intellectuals like Farmer, we must carefully consider
what professionals or institutions—institutional review boards, faculty
advisors, local or international government bodies or authorities—are to
ensure accountability and prudence in day-to-day experimentation with
forms of health research and care in a wide range of complex and difficult
contexts. Here the challenges of accountability in international humanitari-
anism and research come together. The vexed question of appropriate and
feasible mechanisms of oversight and accountability for humanitarian
engagements large and small is, to be sure, not a new one. Initiatives from
the ‘‘1994 Red Cross Movement and NGO Code of Conduct in Disaster
Response’’ and the Sphere Humanitarian Charter to the Humanitarian
Accountability Partnership’s more recent Standard in Accountability and
Quality Management have all attempted, with varying degrees of limited
success, to provide effective, universal guidelines of responsibility to af-
fected populations and forms of self-regulation for humanitarian practice
(Stockton 2005, cf. Darcy 2004, HAP 2013). And in the realm of transna-
tional research processes, Adriana Petryna has highlighted how orthodoxies
of evidence-based clinical science are problematically translated into a
modus operandi of ‘‘experimentality’’ and ‘‘ethical variability’’ when new
pharmaceuticals and medical technologies are tested overseas (2009). While
her analysis pertains specifically to the globalizing of generally large-n clini-
cal trials, Petryna’s reflections seem just as apt for much smaller-scale
research and intervention partnerships like the one I have discussed here.
Petryna urges us to attend to ‘‘gaps between international ethical guidelines
and the social and political realities of research,’’ asking, ‘‘what work is to

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 Sierra Leone: Global Health Education 205

be done to guarantee accountability and to link experimental biologies to

regimes of protection?’’ (2009: 7).
What work, indeed? And what work for anthropology, in particular?
Consequential differences in how key actors (physicians, social scientists,
policymakers, community health workers, ‘‘traditional’’ caregivers) get to
know and understand intended beneficiaries—as data points, moralized
abstractions (‘‘poor Africans’’), or complicated individuals caught up in
webs of structural and physical violence and evolving local strategies of
health, healing, and survival—raise the stakes for anthropological engage-
ment in evidence production and intervention. While questions of ethics
and accountability in research and ‘‘service-learning’’ entanglements may
be vexing, the alternative—to not engage or to assess from an ‘‘armchair’’
position—is much more difficult to justify. Our students, to be sure, will
not allow us the luxury of an overly cynical critical distance. As one wrote
recently in his senior thesis, based on three summers in Sierra Leone
working with Global Alliance, ‘‘how do we see and learn from other lives
if we don’t engage them, and process them in relation to our own evolving
forms of self and social awareness? If previously unavailable experiential
engagements with the realities of healthcare in the developing world are
creating new moral framings, pragmatic considerations and ways of
thinking about humanitarian engagement, then this is, perhaps, a wel-
come move in a field that has only recently been touched by ethnographic
empiricism.’’1 Our students—future caregivers, humanitarians, and schol-
ars, and some likely to be all three at once—hold anthropology account-
able for harnessing and marrying its ethical and empirical-scientific
strengths to the twinned challenges of understanding and addressing the
appalling global health disparities of our era—disparities that they refuse
to write off as intractable, however complexly conditioned they might
be by deep colonial histories, cultural difference, and the global political
economy that implicates us all.

Notes
Except in cases where individuals or institutions chose to be identified, I have
maintained their anonymity to the greatest degree possible through the use of pseud-
onyms and the omission of other identifying features.
1. Unfortunately I cannot cite this thesis directly without compromising the
broader anonymity of Global Alliance for Health.

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206 Locke

References
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Erasures.’’ In When People Come First: Evidence and Innovation in Global Health,
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———. (2013b) Markets of Sorrow, Labors of Faith: New Orleans in the Wake of
Katrina. Durham, NC: Duke University Press.
Becker, Anne, Anjali Motgi, Jonathan Weigel, Giuseppe Raviola, Salmaan Keshavjee,
and Arthur Kleinman. (2013) ‘‘The Unique Challenges of Mental Health and
MDRTB: Critical Perspectives on Metrics of Disease.’’ In Reimagining Global
Health: An Introduction, edited by Paul Farmer, Jim Yong Kim, Arthur Kleinman,
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