When we think of cancer and the South, we often think of a place “without oncology” particularly in Africa where biomedical interventions have long been associated with addressing infectious diseases and improving maternal and child health (Livingston 2012). As the onco-technological fixes of radiotherapy and chemotherapy slowly roll out on the continent, so too do the questions about how to procure radiotherapy sources and chemotherapy vials, and what happens to these toxic treatments after they burn and poison. This paper offers a deep historical and ethnographic analysis of the issue of procuring, reusing, and disposing of the stuff of oncological work at the Uganda Cancer Institute, where I have worked since 2010. The Institute began fifty years ago as a site of chemotherapy research and experiment. Today it serves as the key site of public oncology goods in the Great Lakes Region, seeing over 40,000 patients a year.
At the Institute, the provision of cancer care supplies and drug delivery infrastructure are entangled in a complex political economy of government procurement structures, international partnerships, and targeted donations. Single use syringes and gloves are supposed to be trashed, but are only in stock if National Medical Stores order them on time. Vital pieces of biomedical technology from radiotherapy machines to autoclave sterilizers often come onto the scene used, second hand, and in extreme cases clandestinely dumped, rather than disposed of in the West. Technologies of protection and prophylaxis unevenly appear on the scene as donor gifts, as material reinforcements at emergency treatment centers, or as personal equipment in a foreign national’s duffel bag. In other words, one country’s old medical waste is another country’s new medical gift. And medical waste itself, even if it’s physically plastic, has a degree of plasticity and malleability.
The talk takes us into the material practices and embodied experiences of administering drugs that have powerful, violent effects. The drugs themselves are toxic and are harmful not only to the cancers they target, but also to the patients who endure them and the health workers who administer them. The physical spaces of the chemotherapy mixing station and the drug administration chair can amplify these harms, due to minimal ventilation and crowding. Building on these issues, I draw out three central contradictions in oncological practice at the UCI: the thin line between disposability and reuse; the contradictions of scarcity in a place of abundance; and the (longstanding) theme of healing and harming in health work.