Teaching guide for Mistreated

The following guide was developed to provide additional resources and teaching ideas to accompany my book, Mistreated: The political consequences of the fight against AIDS in Lesotho. This guide is mostly intended for upper-level undergraduate or lower-level graduate courses in global health, anthropology, policy and development studies, or African studies.

Accessing the book

Many libraries have access to an electronic version of Mistreated that students can read online. If you are teaching in the University of Washington system, the link to the online book is: https://orbiscascade-washington.primo.exlibrisgroup.com/permalink/01ALLIANCE_UW/1juclfo/alma99162036172901452

Supplemental readings

Development and politics in Lesotho

  • James Ferguson’s The Anti-Politics Machine is a classic development critique which focuses on development projects carried out in Lesotho in the mid-1990s.
  • John Aerni-Flessner, a historian of Lesotho, has also written several articles on development politics in Lesotho which helpfully pre-date Ferguson’s account. “Development, politics, and the centralization of state power in Lesotho, 1960-75” (2014, Journal of African History 55(3):401-21) is particularly useful in this regard.
  • These two texts (or parts of them) could be assigned along with the book to develop a better understanding of how politics has been intertwined with development and health projects over 5+ decades.
  • Bayart’s classic texts on African statehood and the politics of eating would work nicely with discussions of the meaning of ‘eating’, blood, hunger and HIV treatment throughout.

The unequal politics of global health

  • Johanna Crane’s piece, “Unequal ‘Partners’. AIDS, Academia, and the Rise of Global Health” (Behemoth, 2010: no. 3) provides a useful overview for students of the rise of global health, the central dominance of Western organizations / institutions within the field, and the unequal partnerships this dynamic creates.
  • To that end, along with colleagues I published a special issue of Medicine, Anthropology, Theory on the inequities of US global health partnerships in Africa, with a number of excellent articles – http://medanthrotheory.org/issue/5-2/
  • Betsy Brada’s 2011 piece, “Not Here: Making the Spaces and Subjects of ‘Global Health’ in Botswana” (Culture, Medicine, and Psychiatry 35(2):285-312) is a useful interrogation of unequal imaginings of place and belonging within global health projects and public-private partnerships (including those involving students).
  • Randall Packard’s A History of Global Health is excellent and has a number of chapters that help contextualize the broader global history of HIV treatment scale-up, and its ramifications for institutionalizing the field of global health.
  • Pfeiffer and colleagues have a wonderful short piece from the Lancet which describes some of their efforts to make NGO – government relations in Mozambique around HIV programming more equitable (“The end of AIDS and the NGO Code of Conduct” Lancet 384(9944):639-40.)

Garment production, humanitarian fetishism, Product(RED)

The “End of AIDS” and what comes next

Films / Videos about Lesotho

  • The Forgotten Kingdom isa magical-realist take on migration, HIV, tradition, and family in Lesotho.
  • Lesotho features as a case study in the film FLOW, a documentary on water privatization around the world. This is a nice short clip that can be used to highlight how environmental issues and privatization impact livelihoods in Lesotho.
  • As a piece of ethnographic data, the Product RED / Bono film, The Lazarus Effect, is particularly interesting as a narrative of treatment triumphalism.
  • Several films in the HIV series Steps for the Future feature Basotho youth discussing issues related to HIV, sexuality, and stigma.
  • This short ad from Nike / Product RED captures the “end of AIDS narrative” that is discussed in the end of the book: https://www.youtube.com/watch?v=sgE2yfs1s3A

Related media

  • Partners in Health often posts ethnographic-style blog posts about its work in rural Lesotho, where it focuses on HIV, TB, and maternal health: https://www.pih.org/news
  • Oxfam published a damning report several years ago about Lesotho’s public-private partnership tertiary care hospital. It’s a compelling account of how PPPs are often politicized and set up to fail public systems in placecs like Lesotho
  • MSF has a short video on why pregnant women with HIV are still dying in Lesotho:
  • Photos of Lesotho by Mpho Sephelane
  • Photo essay on MDR-Tb in Lesotho
  • “The price of gold” photo essay on Silicosis in miners in South Africa (many of them Basotho)

Assignments / Activities related to the book

  • I find that using “book clubs” when teaching ethnographies is quite helpful. Students meet in small groups in person and online to discuss the book from week to week as they read it. I meet with each small group to discuss emerging themes about halfway through their progress in reading. Each book club presents an in-depth oral presentation on a chosen theme from the book. Possible themes: representation and voice; culture and HIV treatment; community solidarity; rights and responsibilities; public and private institutions in global health; self-sufficiency and dependence; the politics of recipiency; food, bodies, and HIV.
  • Have students use data / ethnographic stories from the book to brainstorm and develop better representation / communication systems for global health projects. Students may be eager to develop new technological solutions to address this challenge. If they do, help them think critically about the barriers and opportunities of using technology in this context (show them data on internet connectivity, discuss the costs of data connection, perhaps discuss Facebook’s recent agreement with Vodacom Lesotho to provide free access to the internet via Facebook – http://www.itwebafrica.com/more-countries/lesotho/245448-vodacom-lesotho-facebook-launch-free-connectivity-service).
  • Have students map out an ‘upstream / downstream’ diagram of threats to HIV treatment adherence and interventions to improve adherence, based on data and stories from the book. What forces (particularly upstream ones) make it challenging for patients to remain on treatment?
  • Use one of the two narratives presented in the conclusion of the book –by Gates Foundation and World Vision – to envision / write an alternate version of one of these stories that better shifts “how we tell the stories of global health, how we represent and imagine the impacts of its efforts, and how we envision recipient countries like Lesotho” (p. 200) as described in the book. What would this narrative look like, who would tell it, what medium(s) would it use? Encourage students to think creatively about how these alternate narratives could be brought to, and mobilize, the public.
  • Have students examine the work of the NGO Code of Conduct, which aims to address inequities between NGOs and the health systems in which they work.
  • Have students look at the more recent work of WorkersRights.org to establish better mechanisms for ensuring the rights of garment workers in Lesotho (evidence from my research helped inform this project’s research and policy proposals). Based on what we learned in Mistreated about the livelihoods and working conditions of workers in Lesotho – as well as the motivations and interests of the garment industry and its development partners – what do you think will be the strengths, opportunities, weaknesses and threats of this new project? Have students develop a SWOT analysis based on data from the book as well as the Workers Rights report on factory conditions from 2019.