A profound reflection on the social orchestration of hope and futility in an African hospital, the politics and economics of healthcare in Africa, and palliation and disfigurement across the global south

In Improvising Medicine, Julie Livingston tells the story of Botswana's only dedicated cancer ward, located in its capital city of Gaborone. This affecting ethnography follows patients, their relatives, and ward staff as a cancer epidemic emerged in Botswana. The epidemic is part of an ongoing surge in cancers across the global south; the stories of Botswana's oncology ward dramatize the human stakes and intellectual and institutional challenges of an epidemic that will shape the future of global health. They convey the contingencies of high-tech medicine in a hospital where vital machines are often broken, drugs go in and out of stock, and bed-space is always at a premium. They also reveal cancer as something that happens between people. Serious illness, care, pain, disfigurement, and even death emerge as deeply social experiences. Livingston describes the cancer ward in terms of the bureaucracy, vulnerability, power, biomedical science, mortality, and hope that shape contemporary experience in southern Africa. Her ethnography is a profound reflection on the social orchestration of hope and futility in an African hospital, the politics and economics of healthcare in Africa, and palliation and disfigurement across the global south.

"“This book will find a ready readership among Africanists and medical anthropologists. I envision its wider use in g'lobal health' courses, where it will challenge aspiring health workers accustomed to locating hope for medical development in scalable technical interventions... Cancer care, Livingston shows us—like medicine, like development—often requires starting over, usually entails improvisation, and always calls for hard labor by particular individuals in the face of destructive political and economic forces. Improvising Medicine reminds us effectively, sometimes devastatingly, how intractably human this thing called 'health care' is.”" - American Ethnologist

"“This is an excellent ethnography that should (and undoubtedly will) be read and taught by anthropologists, historians, science studies scholars, and interdisciplinary scholars of Africa…. students and practitioners of global health should be reading Improvising Medicine, in which African cancer is made visible and the clinical science of oncology is never divorced from the moral labor and political conditions of care.”" - African Studies Review

"“Improvising Medicine is best suited to those who are interested in global health or who provide medical care across cultures. While its primary subject is cancer, the points the author makes regarding the view of medical care priorities in resource-poor countries, as well as the culture-dependent experience of disease, are well taken and can be applied to work in other areas of the world.”" - Family Medicine

"“In Improvising Medicine, Julie Livingston presents a vivid ethnography of cancer management in an African hospital ward...This book is rich in textual and visual data and is theoretically well informed. It is a model of ethnographic work and an excellent monograph in global medicine and health systems research.”" - Social History of Medicine

"“Although this scholarly work explores a harsh and distressing reality, it is well written, with a warmth and compassion that will make it accessible and appealing to a broad readership… This book will have a direct and sustained impact across fields of social sciences and medical humanities – as it can provide an important perspective often lacking within the paternalistic global health debates.”" - Journal of Southern African Studies

"“Improvising Medicine is an exquisite ethnography, replete with both specific, richly observed encounters at a cancer ward in Botswana and broader, urgent arguments for anthropology and global health. . . . Drawing on beautifully rendered ethnographic evidence, Improvising Medicine tells a compelling story that is relevant for anthropology and beyond.”" - Journal of Anthropological Research

"“That Improvising Medicine is at times difficult to read is a testament to Livingston’s observational and storytelling skills, her ability to allow us to imagine what it might feel like to be a patient, caregiver, nurse, or doctor in an African hospital. This is a remarkable book that deserves and will surely attract a wide readership.”" - Journal of African History

"Improvising Medicine is a brilliant and groundbreaking hospital ethnography, one that grips the reader with its narratives of an institution characterized by constant precarity, where supplies, medications, procedures, and staff are never assured.... Improvising Medicine should interest diverse audiences. These include medical anthropologists, sociologists, social historians of Africa, public health specialists, and scholars across disciplines with interest in the cultures and practices of biomedicine, the morality of care, and the comparative analysis of medical ethics." - Medical Anthropology Quarterly