UCSF

Some Butterflies Did Come is an ethnography of people’s relationships with life, death and care in Kono District, Sierra Leone, as made visible through their withdrawals from regimes of global health. Kono, with its high mortality rates and deeply impoverished rural healthcare system, has been a ground zero for evolving phases of humanitarian global health. But as regimes of care targeting varying crises, epidemics, and patient populations have come and gone, the quandary— why are patients not seeking out care, even when it is available?—has consistently recurred. Drawing on twelve years of engagement with the region, I eschew rational-choice paradigms for addressing these withdrawals, and instead attune to the uncertainties, ambivalences, dispositions and affects that shape people’s trajectories through Kono’s plural landscapes of health and care.Each chapter presents an ethnographic immersion in a particular domain of everyday life that colors people’s relationships with regimes of global health. From Kono’s diamond mines to Paramount Chiefs’ compounds, remote public clinics to non-governmental organization (NGO) offices, I trace patients’ everyday encounters with postcolonial politics, political economies and landscapes of local healing, and their entanglements with fleeting but often-illusory regimes of humanitarian care. These serial “humanitarian juggernauts” have brought with them spectacular promises and possibilities, yet, at the same time, the threat of arbitrary death has remained for many a proximate and lived-with presence. Across different phases of global health concern—war survivors and pregnant women, chronic disease patients and those suffering from Ebola—I follow patients as they seek out and then withdraw from Kono’s healthcare system. I center how these encounters with regimes of global health are perceived proprioceptively—that is, in terms of my interlocutors’ embodied senses of place and positionality vis-à-vis care as they endeavor to maintain balance in and live through a world wracked with life- making and -breaking contingencies. Throughout, I consider whether these withdrawals from care might constitute a peeling-away from, critique or refusal of the illusory promises of neoliberal global health that at once have great bearing over relations of care in Kono, while consistently leave intact the structural conditions of people’s vulnerability to capricious illness and death.