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Book review
Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic
  1. Ben Kasstan
  1. Correspondence to Ben Kasstan, Department of Anthropology, Durham University, Durham DH1 3LE, UK; ben.kasstan{at}

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Julie Livingston. Published by Duke University Press, 2012, paperback, 248 pages. ISBN: 978-0-8223-5342-3, £15.99.

Written with harrowing honesty and rich emotion, Julie Livingston's book offers an insight into the extraordinary practice of the sole cancer ward in Botswana, and narrates the pathways of its patients, nursing staff and imported oncologist (Dr P). Botswana is unique in Southern Africa by having universal access to healthcare for its citizens and the boldness to reorient its health service in Gaberone from HIV and maternal–child health towards the challenges of a rapacious cancer epidemic. The book is therefore unique in addressing the intricacies of this process in a ‘middle income country’.

Using ethnographic research, the author (re)constructs cancer, pain and illness experience in her field-site as a mirror of the emerging health challenges across Southern Africa. The book is laden with the author's own anecdotes and some controversial recollections, which test the boundaries of ethnography or participant-observation on occasions. This makes Improvising Medicine a critical contribution to what medical humanities can entail, and shows how creativity in methods and outlook can enrich the capacities of this emerging discipline. As made explicit in the book's title, of particular interest is the flexibility of oncology care and the ways in which meaning and understanding are created by patients, relatives and healthcare staff as cancer is experienced.

In chapter one, Livingston begins to introduce cancer in Botswana (Sestwana; Kankere) as a clearly different phenomenon from that experienced in North America. The epidemiological differences cannot be understated, as a greater number of neoplasms are presented to …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.