Laura A. Meek
When I began fieldwork in Tanzania over a decade ago, I originally set out to observe the scientific practices through which counterfeit drugs were identified at a regional hospital in the Southern Highlands.1 This hospital had a mini-lab for conducting a Thin-Layer Chromatographic (TLC) test, but for years lacked the iodine detection reagent needed to carry it out. Instead, I came to learn, science was happening elsewhere; not always in the laboratory or hospital, but—perhaps even more frequently—in drug shops, marketplaces, and homes. I encountered a kind of radical empiricism as my interlocutors tasted, smelled, felt, and consumed pharmaceuticals to test their qualities and discern which ones were chakachua (adulterated). Where institutionalized science has been systemically incapacitated by the logics of colonialism, neoliberalism and structural adjustment policies, debt and racial capitalism, these speculative practices are employed to enable knowledge of pharmaceutical efficacy. In this essay, I approach these embodied experiments as a form of fugitive science that also challenges the coloniality of contemporary global health and its “call to order” (Harney and Moten 2013: 131).
Global health policy documents and news reports may give the impression that the category of “counterfeit drug” is rather straightforward. Such accounts provide seemingly self-evident figures like: “42% of detected cases” from 2013 to 2017 were in Africa (Cartwright and Baric 2018: 2) and “the proportion of fake pharmaceuticals in some countries can be as high as 70%” (Mwai 2020). Meanwhile, the World Health Organization (WHO) emphasizes the scale of this global health challenge, noting that: “data strongly suggest that the greater the efforts made to look for substandard and falsified medical products, the more of them are found” (WHO 2017: 12). But, subtending this framing lie assumptions about whose standards determine what is “false,” “fake,” or “substandard” to begin with. And, we might ask, what actually happens on the other side of this limit, as individuals engage these substances in their everyday lives? In Tanzania, I found that pharmacists routinely sell expired drugs and that some vendors also “play with” (kucheza na) the packaging of drugs; for instance, changing the listed country of origin in recognition of the fact that medicines from Europe can be sold for much more than their counterparts produced in the Global South. As these examples demonstrate, “falsified” pharmaceuticals are often partially or even wholly effective.
Among my interlocutors, the Swahili neologism chakachua is used to refer to all such forms of adulteration. While other terms—like bandia and feki—translate more seamlessly into English as counterfeit and fake, the word chakachua is trickier. This term was coined during the 2010 national elections, in which much of the country argued that the results were rigged (or chakachua). My interlocuters define chakachua as “manipulation,” explaining that it refers to any situation in which something’s “reality has been altered.” Chakachua is used to characterize deceptive marketing strategies, students cheating on exams, forged government documents, low-quality consumer goods, and even dishonest lovers. Its creation and popularity capture a broader sense that nothing is entirely what it claims to be and that such duplicity and deception is a structuring force of postcolonial life. In this context, simple binaries between real and fake are inadequate to describe any products, including pharmaceuticals. Nor is laboratory science of much use for my interlocutors who navigate this ethico-onto-epistemic complexity (Barad 2007).
One particularly infamous case of chakachua pharmaceuticals involved antiretroviral drugs (ARVs) which were distributed throughout public facilities by the Tanzanian government in 2015. These ARVs were discovered to be either fake or expired (with different news outlets reporting different versions of the story), and several high-ranking government officials were taken to court over the case. Although some of my interlocutors claimed these drugs had come from India, others told me they were produced within Tanzania. At the local hospital where I did fieldwork, these drugs were discovered to be chakachua by patients who observed that the substance inside the capsules was “like ugali” (porridge) rather than “like maize.” Through seeing and feeling—with both practices understood as “kuona” in Swahili—actors discerned that the texture was suspect; it felt/appeared sticky rather than dry and granular, so patients returned to the hospital and, together with dispensary staff, shook capsules to determine which were still good, “which ones were shaking well like sand.” In contradiction to official procedures for disposing of adulterated drugs, pharmacists then exchanged the ugali-texture pills for sand-texture ones.
These techniques of testing and triaging are acts of care performed to save lives in a context where stock outs of all medicines are routine rather than exceptional. When “proper” procedures for disposing of chakachua drugs are followed, it elicits moral outrage and political rebuke. At the height of the ARV scandal, for instance, the tabloid Ijumaa ran a front-page story with undercover photographs and the headline: “THIS IS NOT OK! While people die for lack of pills, shipments of medicines are wasted in the hospital, they are being thrown out in the rubbish heap” (D. S. 2015).2 The story’s anonymous author claimed that medical personnel from the Morogoro regional hospital had secretly reported this incident to raise public awareness about wasted medicines. The unmistakable message was that disposing of expired drugs—en masse—was scandalously necropolitical.
Embodied experiments to decipher drug qualities defy state and global health mandated procedures. They evade the “best practices” of institutionalized science, substituting these with “maverick, incompliant, bad science” (Bharadwaj 2014: 85). I conceptualize so-called incompliant, errant postcolonial experimentation as “fugitive science,” drawing from historian Britt Rusert (2017) who coined the term to describe how 19th-century African Americans challenged the racist “science” of that era.3 By broadening definitions of science to include situated and embodied practices of testing, sensing, kuona, and experimenting outside academic, corporate, or institutional spaces, I join Rusert in conjuring a capacious science that can include all forms of radical empiricism. This experimentation is “radical” in that it speculatively opens bodies, practices, and drugs to new potentialities—augmenting reality—rather than classifying and reducing what is (Deleuze and Guattari 1987; see also Neely and Meek 2022). It enacts a speculative and open-ended refusal to cancel excess or police boundaries, like those between real and fake, understanding that such epistemic conceits are formative to a colonial (white) science that purifies knowledge from belief, knower from known. No such totalizing desires compel fugitive science.
Scholarship in Black Studies theorizes fugitivity as neither overt resistance nor total escape, but rather as inhabiting the tension of both/and. In Stefano Harney’s and Fred Moten’s (2013) writing on the undercommons, blackness itself, “by way of Fanon, is the willingness to be in the space that has been abandoned by colonialism, by rule, by order” (Halberstam 2013). Abandonment is an apt description for the decades of neoliberal deregulation and privatization that has left the Tanzanian healthcare system under-resourced (Dilger 2012; Meek 2021), compounding the epidemiological devastation wrought by colonialism and its concomitant efforts to dismantle local healing practices (Langwick 2011). Fugitive science is critical in such spaces where institutionalized science has been systemically incapacitated: Recall the TLC test, donated by an Italian NGO, but never performed because there is no money to purchase the iodine detection reagent. Postcolonial scholars also elaborate on this abandonment as an operationalization of racial capitalism (Bhattacharyya 2018), with Achille Mbembe dubbing this “black reason” in an effort to capture the entwining of economic, epistemological, and psychic violence in Africa (2017).
Part of the political significance of fugitive science in Tanzania also lies in the fact that Africans have long been—and continue to be—the objects of Western scientific experiments. Colonial Tanganyika was treated as a “living laboratory” of scientific research, development experiments, and social engineering (Graboyes 2015; Tilley 2011; Wenzel Geissler and Molyneux 2011). In contemporary Tanzania, clinical trials are conducted on populations who will almost certainly never be able to afford the medicines their bodies bring to the market. Meanwhile, racist notions of Africans were formative to the very development of Enlightenment reason, its notions of science, and even the “invention” of Africa itself (Mudimbe 1988; Wynter 2003). African knowledges were described by early anthropologists as intuitive, practical, sensuous, superstitious, experiential—but never scientific. The “‘natives’ became samples, specimens, data, and, at best, informants, rather than intellectual agents in their own right” (Mavhunga 2018: 14). Africa was—and still is—apprehended as a continent cast in shadow, harboring threats that might engulf the world, but incapable of producing truths or knowledge of global significance (Mbembe 2017). It is in light of this longue durée that I read my interlocutors’ experiments not only as practical responses to uncertain conditions, but also as furtive forms of resistance to their relation to science as merely its objects.
The fugitive science I encounter in Tanzania entails a deep knowledge of material, sensory, and aesthetic qualities of pharmaceuticals. Medical practitioners and patients often identify chakachua medicines through qualia such as color, texture, smell, and taste. This is how Dr. Nonde learned of chakachua drugs in his pharmacy.4 One day, he opened a tin of tetracycline (an antibiotic) and observed that there were powdery patches around the sides, but, unsure what this meant, he started selling them. One of his patients discovered these drugs were chakachua after opening a capsule to pour onto a leg wound.5 Inside the capsule, the man saw white powder instead of brown, so he returned to Dr. Nonde’s pharmacy complaining that “the powder inside is in another manner.” Together, they each tasted it and determined it was chakachua because it “tasted sweet like cassava; not bitter, just sweet.” “Every drug has its own peculiar taste,” Dr. Nonde explained. After this, he tasted a pill from each remaining canister in his stock, determined to sell only the ones whose bitter quale indicated potency.
As with any kind of minor science, such speculative practices are at risk of discipline and enclosure. Consider, for instance, Tanzania’s National Action Plan for Antimicrobial Resistance, initiated at the urging of the WHO. The Plan’s objectives include “strengthening patient and health care provider compliance” and “monitoring and evaluating the use and consumption of antibiotics at all levels” (WHO and Tanzanian Ministry of Health 2017: ix). The Plan seeks to “promote behavioral change” and install “new attitudes and practices” to be “embedded in the whole society” (p. vi). While I agree that antimicrobial resistance is a serious and urgent concern, I hope to shift the anxiety it engenders to something more akin to uneasiness. As Didier Fassin (2007: 272) notes, “anxiety” compels us to fortify our own security at the expense of others, while “uneasiness” is a discomfort that forces us to consider, to remember, and to remain open to different readings and divergent possibilities.
How should we interpret this Plan’s assumption that Tanzanians are not already well-informed about the use of antimicrobials? My interlocutors know the color, texture, taste, effects, and other qualia for more drugs than I can even document. The fugitive science they employ is precisely about remaining so informed, conducting ongoing, nimble, and deliberate experiments in a context where the qualia—and hence quality—of any drug cannot be taken for granted. Similarly, what to make of the assumption that the problem in need of intervention is people’s knowledge, attitudes, and behaviors? If this Plan succeeds in convincing public doctors to burn all expired drugs—rather than testing them to decipher which are still potent—what will happen when there are no medicines left? If this campaign changes such “behaviors” without providing the iodine detection reagent needed to test for substandard drugs in a laboratory, if all it does is tell people to stop experimenting outside institutionalized spaces, is it not also telling them to die? To die to keep others in the Global North safe from harm?
This bespeaks the logics of global health biosecurity, which is concerned with the movement of biological threats across borders and thus prioritizes surveillance and preparedness (Lakoff 2010). Global health interventions are deployed almost irrespective of their impacts on target communities, their very “targeted” nature a condition of containment and control. The corresponding global health research increasingly treats such communities’ participation as a political imperative, but, crucially, not as an epistemological one (Biehl 2016). In this apparatus, the limited notion of science presumed in such interventions contributes to further entrenching biopolitical processes that leave racialized populations disproportionately vulnerable to disease and death (Carney, Chess, and Rascon–Canales 2022; Davis 2019; Mbembe 2017). The failure to apprehend the validity and value of embodied experimentations targets for destruction not only individual people but also their practices and the forms of life within which they are embedded (Stengers 2008). In short, the enclosure of Science is a form of anti-Blackness.
Fugitive science challenges both this anti-Blackness and the coloniality of global health, including how it seeks the eradication of others’ practices “in the name of the common goods of progress, civilization, development, and liberal inclusion” (de la Cadena and Blaser 2018: 3; Richardson 2019). To this list, we may add “health,” when understood as only achievable through adherence to institutionalized biomedical science (Adams 2010). Dr. Nonde and his patients’ knowledge that “every drug has its own peculiar taste” is fugitive in relation to public health frameworks that actively seek to regulate, standardize, and/or eradicate such practices; to replace them with “compliance.” Being beyond the limits of a totalizing (white) science, the careful labor of pharmacists helping patients shake ARV capsules is also canceled; these medical practitioners are rendered charlatans in need of “behavioral change” and a “new attitude” (Stengers 2003). Even the senses are fugitive here, being deployed against the hegemony of lab-based indicators.
Still, fugitive science will continue, against, alongside, and—at times—from within this global health apparatus. Through “nimble and strategic practices that undermine the category of the dominant” (Campt 2014 quoted in Sojoyner 2017: 516), fugitive science challenges the containment of science within spaces of global capital, laboratories, and the neoliberal state. It is neither resistance nor escape, but a refusal of the choices being offered, a refusal of “the call to order” (Harney and Moten 2013: 131).
Notes
1 I have conducted approximately three years of ethnographic fieldwork in Iringa, Tanzania (2011–2018) investigating the social dynamics and concerns that inform pharmaceutical use there.
2 Translated by the author from the original Swahili, which read: “HII SIYO SAWA! Huku watu wakifa kwa kukosa kidonge, shehena za madawa zaharibika hospitali, zatupwa jalalani.”
3 The scientific interventions Rusert writes about were conducted by nonprofessional scientists, writers, and artists; took place in spaces like gardens, churches, and parlors; and drew on diverse forms of empiricism, including craniology, astrology, and conjuring.
4 Dr. Nonde is a pseudonym.
5 This is a common practice because it is much less expensive than purchasing antibiotic ointments.