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Abstract
In “the North” ultrasound has become a standard procedure in reproductive health services. In Sub-Saharan Africa where diagnostic imaging technology is increasingly transferred to, ultrasound is still quite a new technology. Its promotion as “appropriate” technology by international donors, however, overlooks the fact that ultrasound such as any technology when transferred is not automatically doing what it is intended to do. Rather, ultrasound may be used very differently. Hence, what ultrasound will actually do remains an empirical matter. This article offers an insight into the multiple constructions of ultrasound that exist in one hospital in Northwest Tanzania as the technology is appropriated by nurse-midwives, doctors, students, local healers, and pregnant women. If these emerging situated ultrasounds are made explicit, the question of whether a technology is appropriate becomes more complex than the ubiquitous term suggests.
Notes
Fieldwork between 2004 and 2005 was funded by WOTRO/NWO and was undertaken as part of a PhD position at Maastricht University. Between 2007 and 2010, I undertook research on another aspect of reproductive health and was able to re-visit previous field sites; this was financed by Max Planck Institute for Social Anthropology in Halle, Germany. I am most grateful to these institutions and to the women and health care professionals who shared their time and experiences with me.
Hospital S., Mr. Chanika, and Pendo Daima are pseudonyms to protect the respective institution and individuals.
As a Designated District Hospital, Hospital S. has to follow government regulations (e.g., prices for services, drug administration, etc.); staff is partly paid for by the government and partly by the hospital's founding members and by private donations. Like private facilities, many Designated District Hospitals do not only depend on central supplies from the Medical Store Department but also have their own financial resources so that supply and services tend to be better than those provided in government facilities.
The labor ward of Hospital S. has nine delivery beds. In 2009, the number of deliveries in Hospital S. was 9552, thus the delivery beds are hardly ever empty (Annual Report of Hospital 2010), and women often have to deliver lying on the floor.
Obstructed labor may result in fetal distress, eventual death, and uterine rupture.
The mode of placenta management, currently followed by Tanzania, is called Active Management of Third Stage of Labor and involves the routine administration of drugs that make the uterus contract (uterotonics) followed by “Controlled Cord Traction,” a steady pull of the umbilical cord in order to deliver the placenta after signs of placenta separation are positive.
Kioo in common Kiswahili refers to “mirror.” In my understanding, the monitor of the ultrasound device led to the use of this term. Yet, its usage for X-ray could also have led to its simple extension to another imaging technology.
The term used in Kiswahili is dawa za kizungu. Kizungu denotes “foreign”’ rather than merely “white,” as in contrast to dawa za kienyeji (local medicine). Yet because biomedicine in this area was introduced by white (Dutch) missionaries, kizungu also carries this notion of white as opposed to African.
The sex of a child is not particularly important in this area. Wasukuma families usually prefer to have equal numbers of boys and girls. This might partly have to do with the fact that the bride wealth a family gets for a girl is needed to marry off a boy.