Dr. Meredith G Marten

More than a decade ago, at the beginning of my doctoral fieldwork, I was kidnapped and robbed one morning in Dar es Salaam, Tanzania. As I negotiated the logistical and emotional aftermath of this traumatic event, I took refuge in elite, privileged spaces. In doing so, I grappled with difficult problems: my privilege, my fear and feelings of vulnerability, and my broader moral concerns about Tanzania's poverty, gross wealth inequities, and the impacts these have on public health. Here, using Harrison's framing of multiple consciousness , I reflect on my vulnerability and privilege, and how they illuminate the impact the kidnapping had on my research and my perspectives on knowledge production. I call for our discipline to continue dismantling narratives of heroic fieldwork and to make more compassionate space for honest stories of our mistakes and privileges. Doing so would allow anthropologists to more faithfully account for fieldwork's messy unpredictabilities and tangled relations.

Senegal has long relied on local communities to expand health services and improve health outcomes for citizens and is internationally lauded for its effectiveness in promoting good health and facilitating local trust. Here we examine how community health care emerges in Keur Toma, a rural Wolof town in the Senegal River Valley that relies on a global network of labor migrants to fuel its remittance-based economy. Largely through its hometown association and the migrant men abroad who fund it, Keur Toma has built and sustained the local health infrastructure and staffing essential to achieving health care accessibility, providing consistent investment and critical stop-gap funding when government assistance falters. Following Robbins's call for investigating "an anthropology of the good," we highlight the deeply rooted sense of care and obligation to kin and community that fosters the translocal ties that make Keur Toma's health care possible in the state's absence. We highlight what Ngom calls "sanctified suffering"-which valorizes personal fortitude and the ability to endure hardships for family and community, shaped by traditions of solidarity, mutual aid, and Islamic morality-and its role in migrants' hometown commitments to building stronger communities.

Forensic anthropology has recently and publicly grappled with fundamental disciplinary issues-including estimating population affinity, the pursuit of objectivity, and the role of bias in medicolegal contexts-all of which has left the subdiscipline in a state of seeming fracture, with many practitioners worried about its future. Given these concerns, we wondered to what degree polarization exists, if at all, and along what lines. Using the method of cultural consensus analysis, we asked forensic anthropologists: What makes a "good" forensic anthropologist? Our findings suggest that contrary to widespread concern, broad agreement (consensus) exists over the training, experiences, perspectives, and practices forensic anthropologists (n = 103) identified as important for being "good" at what they do. A few points of disagreement emerged-particularly over the issue of neutrality-which dominated the narrative feedback we received. The fault lines of this debate primarily fell along generational lines, with those having earned their degrees earlier believing more strongly in neutrality. This pattern largely maps onto broader (and somewhat routine) disciplinary debates and trends away from positivism, with younger anthropologists more focused on the larger goal of "decolonizing US anthropology" and attending to the antiracist work that figures prominently in anthropology today.

Human societies create and maintain structures in which individuals and groups experience varying degrees of inequity and suffering that may be skeletally and dentally embodied. It is necessary to foreground these social and structural impacts for forensic anthropologists to eschew biologically deterministic interpretations of human variation and overly individualistic interpretations of health and disease. We thus propose a ‘Structural Vulnerability Profile’ (SVP), akin to the Structural Vulnerability Assessment Tool of medical anthropology [1], to be considered along with the traditional ‘biological’ profile estimated by forensic anthropologists. Assembling an SVP would involve examining and assessing skeletal/dental biomarkers indicative of embodied social inequity—the lived experiences of social marginalization that can get ‘under the skin’ to leave hard-tissue traces. Shifting our emphasis from presumably hereditary variation to focus on embodied social marginalization, the SVP will allow forensic anthropologists to sensitively reconstruct the lived experiences of the people we examine.
•Traditionally, forensic anthropology emphasizes heredity and individual behavior in interpretations of biological variation.•A structural vulnerability perspective shifts the focus to the ‘upstream factors’ that structure human variation.•These influences include social, political, economic, and environmental determinants of health.•We propose a Structural Vulnerability Profile—SVP—akin to medical anthropology’s Structural Vulnerability Assessment Tool.•The SVP explicitly frames analyses of human skeletal and dental variation within the context of embodied experiences.

HIV and emotional distress often co-occur and interact in syndemic clusters with social, political, and economic factors that amplify the ‘syndemic suffering’ of individuals. In this paper, I describe how HIV+ women seeking antiretroviral therapy (ART) at a hospital in northern Tanzania engaged with plural methods of healing to ease suffering and address the multiple dimensions of illness. I explain the case of a famous faith healer at the time of research from 2011–12, ‘Babu wa Loliondo,’ from whom a third of the women interviewed – 25 of 75 –sought care in addition to their ART. These women experienced significantly fewer symptoms of emotional distress compared with those women who did not, suggesting that either those who sought his care were already healthier, or one strategy for coping – engagement with medical pluralism – played a role in buffering against syndemic HIV and emotional distress.

Fluctuations in global health funding can significantly impact the lives of people who depend on donor-funded programs for life-long care. In this article, I examine shifting HIV policies that expanded antiretroviral therapy (ART) while reducing “care” services meant to improve ART access and adherence. I describe how these changes were experienced by HIV+ women accessing ART at a hospital in Tanzania in 2011–2012, highlighting their increasing precarity and uncertainty for care amidst donor instability and eroding program services. This research suggests that stable funding in support of long-term care services is important to help HIV+ people maintain life-long ART.

Following three decades of international financial institutions implementing austerity measures in sub-Saharan Africa, many health systems remain chronically underfinanced. During this period, countries like Tanzania have moved from a post-independence vision of a strong social sector providing free care for citizens, to a model of increased privatization of public health facilities, shifting the burden of self-financing to individual health facilities and the constituents they serve. Drawing on longitudinal ethnographic research and document analysis
undertaken between 2008 and 2017 within three publicly-funded hospitals in north-central Tanzania, this article examines the actions and perspectives of administrators to explore how novel shifts towards semi-privatization of public facilities are perceived as taken-for-granted solutions to funding shortfalls. Specifically, hospital administrators used “side hustle” strategies of projectification and market-based income generating activities to narrow the gap between inadequate state financing and necessary recurrent expenditures. Examples from
publicly-funded hospitals in Tanzania demonstrate that employing side hustles to address funding conundrums derives from perverse incentives: while these strategies are supposed to generate revenues to sustain or bolster services to poor clients, in practice these market-based approaches erode the ability of publicly-funded hospitals to meet their obligations to the poorest. These cases show that neoliberal ideas promoting health financing through public-private initiatives offer little opportunity in practice for strengthening health systems in low
income countries, undermining those health systems' ability to achieve the goal of universal health care.

The US President’s Emergency Plan for AIDS Relief (PEPFAR) was originally designed as an emergency initiative, operating with considerable funds, immediate roll-out, fast scale-up, and topdown technocratic administration. In a more recent iteration, PEPFAR shifted its focus from an emergency response to more closely account for healthcare sustainability. This transition came on the heels of the 2008 financial crisis, which threatened to stall the ‘marvellous momentum’ of the 2000’s boom in donor aid for global health overall. Now many programmes are having to do more with less as funding flattens or decreases. This paper examines how this transition took shape in Tanzania in 2011–2012, and the successes and challenges associated with it, using participant observation and interview data from 20 months of fieldwork in rural and urban healthcare settings. In particular, I discuss (1) efforts to increase sustainability and country ownership of HIV programmes in Tanzania, focusing on the shift from PEPFAR-funded American non-governmental organisations to Tanzanian partner organisations; (2) principal challenges stakeholders encountered during the transition, including fragmented systems of healthcare delivery and a weakened healthcare workforce; and (3) strategies informants identified to better integrate services in order to build a stronger, more equitable, and sustainable health system in Tanzania.

We examine the cultural context of food insecurity among Inuit in Ulukhaktok, Northwest Territories, Canada. An analysis of the social network of country food exchanges among 122 households in the settlement reveals that a household's betweenness centrality-a measure of brokerage-in the country food network is predicted by the age of the household. The households of married couples were better positioned within the sharing network than were the households of single females or single males. Households with an active hunter or elder were also better positioned in the network. The households of single men and women appear to experience limited access to country food, a considerable problem given the increasing number of single-adult households over time. We conclude that the differences between how single women and single men experience constrained access to country foods may partially account for previous findings that single women in arctic settlements appear to be at particular risk for food insecurity.

In recent years, anthropologists have become increasingly present in medical humanitarian situations as scholars, consultants, and humanitarian practitioners and have acquired insight into medical humanitarian policy and practice. In 2012, we implemented a poll on anthropology, health, and humanitarian practice in which 75 anthropologists discussed their experiences in medical humanitarianism. Our goal was to move beyond the existing anarchy of individual voices in anthropological writing and gain an aggregate view of the perspective of anthropologists working in medical humanitarian contexts. Responses lead to six inductively derived thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography in humanitarian contexts.