Doctoral Dissertation Improvement Grant: Medical Rumors and Humanitarian Relief Clinic Closures in Ethiopia

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In the aftermath of humanitarian crises, numerous people have benefited from antibiotic therapies supplied by international humanitarian relief clinics. Yet when emergency funding dissipates, many of these clinics close, leaving impoverished populations without trusted sources of medication. Preliminary research in rural eastern Ethiopia by Lauren Carruth, a graduate student supervised by Dr. Mark Nichter, suggests that in the wake of relief clinic closures, demand for contraband antibiotics increases, while paradoxically, rumors of bad medicine abound. Although the consumption of non-prescribed antibiotics is common, people may take only a few antibiotics at a time because they fear the local drug supply contains poisonous counterfeit pills. As a result of shortened regimens, even if the medications are genuine, they are likely to be taken inappropriately and ineffectively. This dissertation project asks further: how do relief clinic closures shape local antibiotic practices and informal health economies? And, how are medical risks and medical rumors articulated and acted on within communities, markets, clinics, and international humanitarian relief organizations? The research will be carried out in the remote Shinile Zone of Ethiopia, a locus of transnational contraband trade, recurrent humanitarian crises, and repeated relief operations. Data will be gathered at multiple sites in the Shinile Zone through participatory mapping, in-depth interviews, structured observations, and participant observation. This research is important for its potential to improve social science theory regarding the long-term but sometimes hidden consequences of disaster relief. Unregulated pharmaceutical practices and informal health economies are central to healthcare in Ethiopia, but remain absent from studies of humanitarian intervention, medical systems, or disaster. By affecting medical behaviors, fears of bad medicine and clinic closures may importantly shape local epidemiology, the evolution and manifestations of infectious microbes, future responses to pharmaceutical products, and future health interventions. Most urgently, local strategies of managing the risks of bad medicine by inappropriately consuming antibiotic pills may provide an ideal environment for the development of diseases resistant to the only medications available. The research also will contribute to the education of a social scientist.