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A novel terrain of health care is emerging in Kenya at the intersection of a cancer epidemic, expanding medical and health insurance markets, the continued evisceration of public health care, and a middle class that can raise funds from credit, loans, and social networks. As middle‐class cancer patients and their families navigate these landscapes, they find themselves vulnerable both to the "ordinary crisis" of public health care undermined by austerity and neglect, and to an extractive medical marketplace offering state‐of‐the‐art treatment that is just within, or just beyond, financial reach. To analyze this, I build on Lauren Berlant's concept of cruel optimism, which captures how precarity is not only grounded in economic realities but also tied to hopes and expectations that always remain unfulfilled, creating constant anxiety and exhaustion. Further, I examine the double binds of cancer treatment and the entanglements between medical, health, and economic precarities, as families are drawn into private health care while the state disinvests in public services. [ABSTRACT FROM AUTHOR]

JON HOLTZMAN, Uncertain Tastes: memory, ambivalence, and the politics of eating in Samburu, northern Kenya. Berkeley CA: University of California Press (hb 39.95 [pounds sterling]--978 0 520 25736 8; pb [...]

This essay examines how the publics of public health and those of public domain are reshaping one another in efforts to commercialize and manage modern traditional medicine in Tanzanian universities, government laboratories, nongovernmental clinics, and ministry offices. I argue that struggles over the practices that constitute the public to which contemporary traditional medicine will appeal are also struggles over who is obliged to respond to pain and debility, to mediate the consequences of misfortune, and to take responsibility for the inequalities that shape health and well-being. Postindependence and socialist dreams had cast traditional medicine as the basis of an indigenous pharmaceutical industry and promised freedom from multinational pharmaceutical companies and global capitalism more broadly. By generating new publics, current scientific efforts to exploit the therapeutic and commercial value of therapeutic plants are experimenting with political and social philosophies, with biological efficacy, and with new forms of wealth and property. The uneven, contradictory, and partial projections of the public at play in these efforts are raising thorny questions about the forms of sovereignty that are possible within the neoliberal restructuring. [ABSTRACT FROM AUTHOR]

How are publics of protection and care defined in African cities today? The effects of globalization and neo-liberal policies on urban space are well documented. From London to São Paulo, denationalization, privatization, offshoring and cuts in state expenditure are creating enclaves and exclusions, resulting in fragmented, stratified social geographies (see Caldeira 2000; Ong 2006; Harvey 2006; Murray 2011). 'Networked archipelagoes', islands connected by transnational circulations of capital, displace other spatial relations and imaginaries. Spaces of encompassment, especially, such as 'the nation' or simply 'society' as defined by inclusion within a whole, lose practical value and intellectual purchase as referents of citizenship (Gupta and Ferguson 2002; Ferguson 2005). In African cities, where humanitarian, experimental or market logics dominate the distribution of sanitation and healthcare, this fragmentation is particularly stark (see, for example, Redfield 2006, 2012; Fassin 2007; Bredeloup et al . 2008; Nguyen 2012). Privilege and crisis interrupt older contiguities, delineating spaces and times of exception. The 'public' of health is defined by survival or consumption, obscuring the human as bearer of civic rights and responsibilities, as inhabitants of 'objective' material worlds 'common to all of us' (Arendt 1958: 52). Is it possible, under these conditions, to enact and imagine public health as a project of citizens, animated in civic space?

Over the past fifteen years, the city of Kisumu in western Kenya has emerged as an epicentre of 'global health' interventions, organized by non-governmental and transnational groups. These interventions involve concrete, practical engagements with the city's populations, but also imaginations and desires, as they intersect with residents' expectations of development. This article follows the hopes, aspirations and trajectories of people who attach themselves as volunteers to these interventions, or who hope to do so through a process they describe as 'tarmacking'. In exploring how volunteers orient themselves to ideas of 'empowerment' that are promoted by NGOs and also have influence outside institutional settings, it examines the relations between the landscapes of intervention, the spatial-temporal horizons, and the geographies of responsibility emergent in the city. Through its association with 'moving ahead' and with development, empowerment implies movement towards some kind of future. While there is a widely shared sense among volunteers that they are going somewhere, just where that might be is not clearly articulated. Rather than attempt to pinpoint this destination, this article follows their trajectories in an attempt to grasp why and how it remains obscure.