March 2026 Meeting Notes: Improvising Medicine by Livingston

Our March 2026 LMCC meeting took place on Wednesday, March 25 at 5:30pm strictly over Zoom.

We discussed Julie Livingston’s monograph Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic (Duke UP, 2012). Specifically, we asked everyone to focus on the following:

• Preface (pp. ix-xi)
• Chapter 1: “The Other Cancer Ward” (pp. 1-28)
• Suggested optional reading: Chapter 5: “Pain and Laughter” (pp. 119-151)

If you missed the meeting, you can still access the texts on the Readings page of this site! You can also access the recording of our meeting here.

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We will be in touch soon with more details about our April meeting, which will be our final meeting of the semester and of the 2025-2026 academic year!

Livingston, Julie. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Duke UP, 2012. Duke UP, https://doi-org.libproxy.lib.unc.edu/10.1215/9780822395768.

Meeting Notes (courtesy of LMCC Co-Director Mindy Buchanan-King):

• Announcement that Paul and Mindy will be stepping away from LMCC leadership after the April meeting; please let us know if anyone is interested in stepping forward to lead LMCC.
• Paul: Livingston’s work offers a counternarrative to Western medicine and improvising medicine; pulling back the curtain of being an ethnographer.
• Mindy: Question of how the author becomes enmeshed in the narrative, as in “Pain and Laughter” chapter
• Paul: How the cultural outsider “observes”; you can’t ever truly be an objective observer. How are you being perceived as an observer and a participant?
• Claire: A thread in what is being discussed so far: fresh take on method and writing. It’s a self-reflective practice of involved ethnography. Livingston does have special skills as an ethnographer. Really liked her order of operations and her breaking down of “oncology” as a monolith. Appreciated the sense of ethnography as a way of using a social science method as a way of thinking about what we mean by specialty. Oncology seems like an authority over cancer, but she’s showing that oncology is a collection of small decisions, practices, etc. That’s really fascinating; it’s an argument for the method.
• Paul: Another core argument is that this is all inherently social; cancer is a series of interactions.
• Claire: Love when she writes that cancer—and disease in general—happens among people and within people.
• Carmen: She does use cancer to talk about social interconnections between people, and ways of uniting people in Africa and Western countries, that cancer is a link. When we talk about disease, we think about poorer countries having infectious diseases and Western countries of having diseases that are more indicative of our increased longevity. We tend to think of the latter as more “civilized” and more “progressed.” This work makes the point that cancer is a shared human experience.
• Carmen: She does recognize that cancer is increasing in areas like Botswana. It’s odd to see cancer used as civilizing people, but I think that’s what she’s doing.
• Claire: She does a similar thing in racialized perception of disease. She has a great sentence that “Cancer is the new face of healthcare”—that speaks subtly to the fact that cancer is a human experience. Against the background of AIDS in Africa, she’s telling a new story about disease in Africa. The Susan Sontag of it all, the narrative that cancer doesn’t have the traditional romance or “heroic” narrative. She’s picking up on the association of cancer with biomedicine.
  • Note: The quote Claire refers above to seems to be: “Cancer is a critical face of African health after antiretrovirals (ARVS)” (Livingston 7).
• Mindy: Discussion of religion and spirituality threaded throughout this work.
• Paul: Making meaning out of disease, kind of looking for a revelation, is inherently bound to these questions. Livingston is also challenging the heroic narrative of Western medicine and giving Western readers another perspective. It’s all human, but there is a different perspective. The mundanity the experience is also important; it’s seemingly boring, but there is a need or own kind of suffering there.
• Camille: Livingston is a historian, which raises questions about laughter as a palliation. How she problematizes that she was uncomfortable with them not using opioids/pain medicine, but showing how we don’t want to jump to conclusions as far as being callous or cold. What happens if the pain medication isn’t there? The idea that cancer in Botswana is not ontologically the same, and it’s not epistemologically the same. People in Botswana at the time of the book’s publication didn’t know to fear cancer. In the third chapter, Livingston says TB is feared more than cancer.
• Paul: It’s a good example of ethnography and academic writing. The example of patients getting chemo and the door being closed (for the sake of those inside the room being treated and for the sake of those waiting in the hallway outside) and the visual of those not being seen.
• Camille: Reflecting on talking with undergraduates, one of the nuanced aspects of her book is how is medicine improvised? Many of the students focused on the scarcity of resources, falling back on the imagining of Africa as poor and unable to bring in the resources needed. But Botswana does have the infrastructure, even though they may not have access all of the time to resources. Also, the cancer that is being experienced in the global south is experimental. Many of the cancers are advanced with coinfections. All the vaccines are developed with Western demographics in mind, so all of the medicine is experimental in a way, in that not all of the biomedicine holds there.
• Paul: There is a line early on, in the Preface: “…cancer with oncology was awful, cancer without oncology could be obscene” (xi).
• Claire: It’s a powerful argument for ethnography, not only as description but also as an interruption of assumptions.
• Camille: Livingston touches on how this book could very easily fall into the “white savior narrative.” She’s not advocating for that trope. Dr. P is there, but it’s more complicated than that. Yes, we can see it as paternalism, but we can’t just see it as paternalism because at the end of the day, he is the one who has the resources that have to be distributed. In Botswana, the patient isn’t told their diagnosis because it’s believed such information may speed up their death. Dr. P is having to manage a very difficult task, of trying to convince patients who don’t even know what cancer really is to undergo some very painful treatments.
• Paul: In some ways, this is a very unique medical environment, in both the context of biomedicine and in the shadow of the HIV/AIDS epidemic (and potential mistrust of healthcare systems as a result of that epidemic).
• Camille: That’s a really good point, especially with Botswana being hit so hard by HIV. The visibility/invisibility play is interesting; cancer isn’t visible to patients, yet they are coming in with very visible ailments.
• Carmen: To add to the note about distrust in medicine: many people in Botswana have late-stage cancer, so you have to convince them to take treatment that might not even work.
• Camille: Regarding chapter 5, “Pain and Laughter”: Livingston counters Elaine Scarry’s understanding of pain as individual, talking instead about the relationality of pain. Pain medicine isn’t as easily available, there is a culture of endurance, and there is the question that people bear the pain for you. Livingston notices how people are laughing during the painful experiences, undermining the stereotype that laughter is a sign of callousness. Laughter can be a form of palliation; it can be a way of auto-palliation, of how people treat their own pain.
• Paul: There’s something interesting about this project about the human experience and the missed assumptions. Laughter can be a way of processing. The laughter and pain question is fascinating. We keep going back to everything being social—this is all social.
• Claire: Grateful to Camille for the suggestion of Livingston’s work. Reading a lot of how the illness memoir doesn’t enact sociality; there is a predictability of self-reference.

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Note: The featured image for this post is a photo from Chapter 1, “The Other Cancer Ward.” The caption for the photo says, “The clinic office and exam room” (Livingston 4).