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Eva Vernooij, Francess Koker, Alice Street, 29.03.21
Central to the workings of a hospital are the technical and bureaucratic systems that ensure the effective coordination of information and biological materials of patients across time and space. In this paper, we adopt a patient pathway approach to examine moments of breakdown and repair in the coordination of patient care in a Sierra Leonean hospital. Through the in-depth analysis of a single patient pathway, we show how coordination work depends on frequent small acts of intervention and improvisation by multiple people across the pathway, including doctors, managers, nurses, patients and their relatives. We argue that such interventions depend on the individualisation of responsibility for ‘making the system work’ and are best conceptualised as acts of temporary repair and care for the health system itself. Examining how responsibility for the repair of the system is distributed and valued across the hospital, we argue, is essential to developing more sustainable systems for repair.
Dr Ann Kelly (Kings College London), 26.03.21
University College Dublin Zoom Webinar "Surveilling the Microbiome: Diagnostics, Laboratory Networks & Disease Preparedness".
Dr Alice Street, 28.01.21
As it has in other countries worldwide, Covid-19 testing has dominated the pandemic response in Scotland. The purposes to which testing has been put are manifold, from clinical diagnosis of severe cases in the early stages of the pandemic, to efforts at containment through the identification and isolation of symptomatic cases, to a much vaunted but somewhat vague elimination policy which has only now been accompanied by border testing, to the opening up of the economy through the provision of mass routine testing in schools, universities, workplaces and cultural venues. These efforts have also been characterised by a series of high-profile failures. One of the issues is that tests, in the form of testing numbers or the visibility of mass testing programmes, have become a proxy for government competence, with little interrogation of what tests actually do. Tests do not have any utility on their own – they only provide information. It is up to people to do things with that information. But with so much emphasis on the test as a standalone entity, the question of what happens after a test has been wilfully ignored by politicians and the media alike. Whether for PCR or LFT tests, the existence of testing programmes and numbers of tests have been used to claim political credit or pre-empt criticism, with little accountability in terms of what particular use cases have achieved in terms of containing or eliminating the virus.
Dr Alice Street, Dr Shona Lee, Eva Vernooij, and Dr Michelle Taylor, 27.11.20
Alice Street, 8.10.20
Testing capacity has taken centre stage of the international response to the COVID-19 pandemic. As the epidemic curve has peaked and dipped, so have the meanings and value of testing been dramatically expanded beyond medical and public health uses to include such purposes as restarting economies or regaining intimacy with loved ones. Effective testing strategies have also been revealed to hinge on multiple relationships of trust: including trust in technology, in government, in oneself, and in strangers. In this presentation I will reflect on the social life of COVID-19 testing through research undertaken by a team of social scientists based at the University of Edinburgh and funded by the European Research Council and the Scottish Chief Scientists Office. This research shows that, while promises of certainty are often made for diagnostic tests, the social relationships on which testing depends often generate intense uncertainties in the testing process. Understanding those relationships and the values they embody, I argue, will be crucial if testing is to be effectively harnessed to meet the challenges of the COVID-19 pandemic.
Dr Alice Street and Dr Shona Lee, 30.09.20
Live Zoom Webinar
Testing and Trust is a rapid qualitative study investigating public understandings, expectations and experiences of Covid-19 testing in Lothian, Scotland and how testing strategies influence public trust in health services and government response. The study is being led by the DiaDev project team at the University of Edinburgh’s School of Social and Political Science, and is funded by the Chief Scientist Office’s Rapid Research in COVID -19 programme.
In this live webinar, we reported our findings from in-depth, socially contextualised research into people’s understandings of different Covid-19 tests, their expectations of how and when they should be tested, their experiences of testing and how test outcomes influence behaviour. The presentation was followed by a Q&A and discussion chaired by the study’s Principle Investigator Dr Alice Street.
Shona Lee, 28.08.20
Presented at the Association of Social Anthropologists (ASA) online annual conference 'How to live through a pandemic'
This paper examines how the international response to the 2014-2016 Ebola outbreak helped to prepare Sierra Leone’s health system for COVID-19. It draws on anthropological research on post-Ebola vaccine trials and laboratory strengthening programmes to explore health-worker experiences of epidemic response and preparedness efforts. These on-the-ground experiences and perspectives are under-recognised in evaluative exercises, but are critical to understanding which features of emergency response carry forward as sustainable infrastructures of preparedness. Analysis will centre on the hopes and expectations that technology-centred preparedness interventions foster for frontline workers in under-resourced health systems, the hidden efforts of building robust preparedness infrastructures, and the contribution of anthropological approaches to understanding preparedness as a social process. In describing the additional labour, informal networks, personal losses and social risks undertaken by laboratory and vaccine trial workers in order for protocols and practicality to meet, we reveal the social performance of preparedness. That is, the contextual engineering that make systems work through personal connections and sacrifice. The paper expands concepts of preparedness to include its personal and relational aspects, exploring the knowledge and value systems produced in epidemics. From this perspective, the Ebola response and aftermath helped prepare Sierra Leone for COVID-19 by developing capacity at individual and institutional levels, and blueprinting physical and social infrastructures for cultivating laboratory, vaccine development and clinical research systems. Yet failing to build the social experiences of response work into preparedness programmes risks erasing important knowledge of how these temporary assemblages are stabilised and sustained. COVID-19 has confirmed that the rhetoric of resilience is insufficient to capture the extent and expectation of sacrifice placed on staff. Responding to this pandemic requires investing in the long-term safety, security, and support of people undertaking the work prescribed by protocols, as well as that of making protocols work.
Alice Street, 12.05.20
Presented by Dr Alice Street at the 'Edinburgh Responds' webinar series focusing on the response of Edinburgh academics and clinicians to the Covid-19 pandemic.
The coronavirus pandemic has raised public awareness of the important role of diagnostics in public health.
Demands for more tests for COVID-19 continue to be at the centre of political debate and criticism of governments’ handling of the pandemic, particularly in the UK and the US. The political messaging around testing has underplayed the complexity of diagnostics, particularly in relation to the emergency response.
Political leveraging of diagnostics has placed enormous expectations on COVID-19 tests. They are expected to provide certainty on the pandemic situation the country. They are expected to reassure that the measures taken by the government and health authorities are appropriate for controlling the spread of the pandemic. They are expected to provide a guarantee for people to come out of the lockdown and get back their freedom of movement. Perhaps above all, they are expected to set countries on to the path of economic recovery.
Experiences from DiaDev's (Investigating the design and use of diagnostic devices in global health) research in Sierra Leone in the West Africa Ebola response in 2014-2016, and ongoing COVID-19 related research in India and the UK, show that there are multiple kinds of diagnostic technologies with varying usages and benefits. Different kinds of tests are best operated in different places – triaging patients, for making decisions on clinical care of individual patients and for surveillance purposes.
The focus on getting more and better tests has also diverted attention from building capacity of national laboratory systems, particularly in the low and middle income countries.
Reflecting on these experiences, it is evident that even in a country like the UK, there are weaknesses with the supply chain and the manufacturing system for diagnostics. The focus on point of care diagnostics may be distracting concerned authorities from considering the comprehensive ‘diagnostic system’, from production to marketing, distribution, maintenance and waste management.
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