Eliminating trachoma in Malawi: towards a critical biosocial perspective

Trachoma remains the commonest infectious blinding disease. Its global elimination policy pays little attention to the social, political, economic, and historical context in which it is delivered, assuming universal experience, discrete, linear pathology, and rational human responses. Trachoma exemplifies a need to look beyond a biology and culture dichotomy, taking political ideologies, social relationships, and cultural understandings seriously in global health programming.

This research involves fifteen months of ethnographic fieldwork in Makanjira, Malawi, including participant observation in one village (as resident and trachoma grader), open-ended interviews with diverse stakeholders, and the development of 15 matched case studies (families affected and not affected by trachoma).

The researcher aims to capture local understandings and day to day experiences of life with trachoma, recording social, biological and environmental dynamics that shape people’s vulnerability, and investigating how local, national and global politics are embedded in the public health response. Critical biosocial analysis will show how biomedical categories of diagnosis, assumptions of transmission, and technologies of elimination, shape trachoma at a local level.