ABSTRACT
Based upon ethnographic research during a large TB vaccine trial in South Africa, this chapter explores the challenges that emerge at the interface between scientific and clinical approaches to diagnosing childhood TB. With childhood TB being very difficult to diagnose, we show how doctors, nurses and fieldworkers involved in the trial balanced the need for ‘objective’ clinical data—central to which was a diagnostic algorithm—with the imperative to diagnose TB as soon as possible for the health of enrolled infants. Our aim is to show that this health-related dimension of the trial was more than a by-product of experimental practice. Rather, it took on a life and logic of its own, with staff adopting a context-sensitive, holistic purview for matters of medical concern that often went beyond, at times complemented, but also ran into tension with protocol. In fact, such was such was the effectiveness with which TB was picked up that it might actually have been responsible for the trial’s eventual ‘failure’. The tensions between experiment and care, we will go onto argue, not only highlight the complexities and multi-layered work involved in abstracting ‘childhood TB’ from context, but also raises unsettling questions for the ethics and epistemologies of global health science.
