That “Greater Passivity”: Refusal of Global Health Care and Dispositions Towards Life in Kono District, Sierra Leone

Raphael Frankfurter
Humanities and Social Sciences (Medical Anthropology)
UC San Francisco

My dissertation is an ethnography of people’s dispositions towards life, death, and care in Kono District, Sierra Leone, as made visible through their refusals of global health care. With its high mortality rates and impoverished healthcare system, Kono has been a ground zero for evolving phases of humanitarian global health. But as infrastructures of care targeting specific patient populations have come and gone, a question recurs: Why are patients not seeking out care, even when it is available? My dissertation follows patients across different moments of global health concern—war survivors and pregnant women, chronic disease patients, and those suffering from Ebola—as they seek out and then withdraw from the healthcare system. I explore a collective disposition of skepticism towards care as emergent from people’s everyday encounters with postcolonial politics and their entanglements with fleeting but often-vacuous regimes of humanitarian care.

Drawing on anthropological work on contemporary regimes of biopolitics, public health, and humanitarianism and care, but also on postcolonial theory, Sierra Leonean history, contemporary West African literature, and affect theory, I argue for an ethnographic approach attentive to the everyday affects (rather than “rational-choices”) that coalesce as refusals of care.