Making Uncertainty: Tuberculosis, Substance Use, and Pathways to Health in South Africa

by Anna Versfeld

In Cape Town, South Africa, many people with tuberculosis also use substances. This sets up a seemingly impossible People who use substances are at increased risk of tuberculosis disease; and substance use seems to result in erratic behavior that makes successful treatment of people affected by tuberculosis extremely difficult. People affected don’t get healthy, healthcare providers are frustrated, and families seek to balance love and care for those who are ill with self-protection. How are we to understand this? Where does the responsibility for poor health and healing lie? What are the possibilities for an effective healthcare response? Through a close look at lives and care, Making Tuberculosis, Substance Use, and Pathways to Health shows how patterns of substance use, tuberculosis disease, and their interaction are shaped by history, social context, and political economy. This, in turn, generates new perspectives on what makes poor health, and what good care might look like.

190 pages, Hardcover

Published February 10, 2023

Reviews

[Sam Packer · Rating 5 out of 5]

A Masterclass in Medical Anthropology. Versfeld’s "Making Uncertainty" is a profound exploration of the intersection between TB and substance use in South Africa. Her ability to weave complex social history with intimate ethnography is simply breathtaking.

[Amelia Olivia · Rating 5 out of 5]

The Human Face of Public Health. I was deeply moved by the story of Jeffrey in Chapter 1. Versfeld doesn't just present data; she gives us the "Returners"—the real people behind the statistics of "unruly" patients.

[Jane Maria · Rating 5 out of 5]

Challenging the "Cure" Narrative. This book brilliantly dissects the "TB is curable" sign at DP Marais Hospital. It forces us to ask: at what cost and under what conditions? A necessary critique of individual responsibility in healthcare.

[Istanbul Edebiyat · Rating 5 out of 5]

A Vital Resource for Healthcare Workers. As someone working in the field, Versfeld’s insights into the "stickiness of moral opinion" hit home. It’s a call to move beyond judgment toward a more convivial form of care.

[Chazzy · Rating 5 out of 5]

Stunning Ethnographic Detail. The descriptions of the railway tunnels and the intimate spaces where people live and use drugs are hauntingly beautiful and deeply respectful. Versfeld has a gift for making the invisible visible.

[Amelia Willow · Rating 5 out of 5]

Redefining Uncertainty. Instead of seeing uncertainty as a failure of the system, Versfeld shows us how it is "made" by social and political forces. This shift in perspective is a game-changer for medical anthropology.

[Robert Bryan · Rating 5 out of 5]

Beyond the "Unruly" Label. The chapter on "unruly" patients should be required reading for every nursing student. It humanizes the struggle of those who "fail" treatment and points toward more compassionate pathways.

[William Jason · Rating 5 out of 5]

The Power of Storytelling. Through characters like Lucinda, Versfeld demonstrates how the hospital can be both a place of respite and a place of restriction. Her storytelling is compelling and deeply informative.

[David Scout · Rating 5 out of 5]

Critical Analysis of Global Health Reports. I loved the critique of the WHO Global Tuberculosis Report. Versfeld’s "figure facts" concept perfectly captures how data can both reveal and obscure the truth.

[Bigola · Rating 5 out of 5]

The Intersection of TB and Substance Use. Versfeld tackles one of the most difficult challenges in modern medicine with grace and intellectual depth. She doesn't offer easy answers, but she asks the right questions.

[Bright Zion · Rating 5 out of 5]

Empathetic and Rigorous. It’s rare to find a book that is both academically rigorous and so clearly driven by a deep empathy for its subjects. The balance Versfeld strikes is perfect

[Patrick Brick · Rating 5 out of 5]

A Deep Dive into Cape Town's Health Landscape. Having lived in Cape Town, I found Versfeld’s analysis of the local political economy and its impact on health to be spot-on and incredibly illuminating

[Gosford Rose · Rating 5 out of 5]

A Call for Convivial Scholarship. This book is a beautiful example of what Versfeld calls "convivial scholarship"—research that is lived, felt, and deeply connected to the community it studies.

[Ahmodashimiy · Rating 5 out of 5]

An Eye-Opening Read. I didn't know much about the subacute TB hospitals in South Africa before this. Versfeld’s "Making Uncertainty" opened my eyes to the complexities of care in these institutions.