On March 29th,2021, The Social Change and Development Working Group hosted Dr. Noémi Tousignant, Lecturer at The University College London. Her presentation was titled: Carcinogenic Residues of Global Biomedicine in Senegal. Dr. Tousignant’s work focuses on historical and contemporary intersections of biomedicine with global inequalities in health in West Africa, especially in Senegal.
Dr. Tousignant centered on her current book project, which is in its early stages. The talk began by considering the persistence, or more accurately, the re-occurrence of deaths and of deadly exposures in West Africa. These exposures were defined as carcinogenic. The deaths in question are from liver cancer, of which some West African countries including her study site of Senegal, have some of the highest rates in the world.
She described that the lived intensities of deaths are not captured properly, many of them young men who suddenly develop swollen bellies, loss of appetite, and excruciating pain. Almost everyone that she has spoken to in her networks has a relative or personal or family friend who died from something that sounds like what was described above. She described very delicate and exhausting experiences, faced by those with this disease and those who acted as caretakers. The talk spoke to the tragic banality of preventable death.
Dr. Tousignant transitioned to considering how the history and geography of inequality can be told through the re-occurrence of this particular kind of preventable death. The case of liver cancer in Senegal is one, in which a site and subjects of persistent exposure and death have participated in very tangible ways. In other words, the story of liver cancer is one of the early and rare global success stories in cancer.
Dr. Tousignant explained what progress in etiological knowledge, technological innovation, and regulatory action can also be told from Senegal. She did this by sharing the history of doctors in Senegal collecting information about liver disease in the late 1940’s. This caused a surge of interest in this cancer that was so common in Africa, but rare elsewhere, except for parts of Asia. Liver cancer was as the American pathologist, Paul Steiner, put it–a problem of worldwide significance. In the framework of geographical pathology, its distinctive spatial distribution offered a ready set of clues to be correlated with further observations on distant issues and symptoms.
Dr. Tousignant shared the hypothesis that was formulated during that time; liver cancer and cirrhosis were associated with a history of viral hepatitis infection. In the mid-1960s, United States research on cross reactions between different sets of collected blood revealed a new antigen, which further research defined as part of the newly characterized hepatitis B. There was a transnational endeavor to answer a problem of global significance, that of whether viruses could cause or be proven to cause cancer in humans. It attracted the world’s leading American and French hepatitis experts, including Bloomberg, who won a Nobel Prize for his discovery of the virus. Case control studies involving thousands of Senegalese hospital patients, soldiers and villagers formed an important first step in identifying chronic hepatitis B as the main suspect of liver cancer causation in hot spots like Senegal. This led to the selection in the mid 1970s of assembly site for one of the earliest trials of the hepatitis B vaccine.
Dr. Tousignant spoke about the discovery of aflatoxin in peanuts in the 1960’s after Senegal had gained its independence. This toxic agent and its impact and that peanuts might be carcinogenic came up at a really bad time for the new assembly state, just after independence in 1960. Peanut farming and exports were the lifeblood of the Republic’s first national development plans. The impossibility of losing access to peanut export markets dominated official Senegalese responses to the aflatoxin problem. So, while Senegalese authorities refused to research or even recognize aflatoxin as a carcinogen for the local population, they grudgingly invested in its regulatory control as a presumed carcinogen for European consumers. Aflatoxin control is still almost exclusively experimental or export-oriented, which means that the peanuts, as well as the corn that Senegalese eat, is generally unmonitored, unmonitored, and unregulated.
Dr. Tousignant introduced this concept of narrative tempos as a kind of authority in unpacking these two spaces. What she is trying to do here is to locate the re-occurring carcinogenic exposures in Senegal. In a very specific historical, geographical, and material relations to biomedical progress and protection. For the rest of the talk, Dr. Tousignant explained how she proposed to use the term ‘residue’ as the hint between persistence in progress between what leaves and what remains, and between the deaths and exposures recorded in the archives of research and regulation and those about which I was told in Senegal just two years ago.
This idea of residue in a fairly straightforward way as “what’s left over after the main most valued portion of something is taken out or used up.” Residue isn’t necessarily without value, but by definition it’s of lesser value than what it’s leftover from. This was discussed in the context of persistent Senegalese carcinogenic exposure in its relations to protection exported protection, the protection of others, protection in the past, protection of the future, the past future of the future perfect.
Dr. Tousignant ended her talk with anecdotes about the African public health systems being put on hold under structural adjustment programs. The problems surrounding hepatitis B vaccination and its unbearable cost, where no one was agreeing to buy them because they just weren’t quite cheap enough yet. This illustrates how calculations of which lives should be saved were made during this period, not only as a ratio in the 90’s. The idea that cost in relation to sort of the capacity of the technology of an intervention to prevent death or disability, and therefore to kind of purportedly universal valuation of life, but also that cost in itself, mattered that meeting a threshold of absolute cheapness was acknowledged to be a prerequisite to hepatitis. The vaccine donor put purchasing at the forefront, thereby suggesting a differential valuation of preventable death. With the hepatitis B vaccine, we see a kind of different kind of differential valuation in relation to this threshold of cheapness for preventable death.
At the imminence of that, cheapness worked in an ethical sense as a predicted retroactive erasure of delayed access, and of its expression of unequal valuations of life in relation to positions in the global economy.
The focus of Dr. Tousignant’s book project is to explore modes of writing history that hold together without collapsing. Exploring a narrative of progress in which exposures so widespread in hepatitis B infection and contaminated peanuts are converted into etiological knowledge validated technologies and safe food, thereby transforming global biomedicines and their protective capacities.
Written by: Karen Awura-Adjoa Ronke Coker