Browsing by Subject "African studies"

This dissertation examines the politics of industry and industrialization in Ethiopia. I analyze how multinational alcohol companies and the Ethiopian state are brewing development, meaning spurring the creation of industrial linkages through the production, distribution, sale, and consumption of commercial beer as well as their corresponding socio-cultural consequences as the Ethiopian people respond to such processes. An ethnography at the nidus of corporate supply and value chain management and the state’s industrialization policy, the following pages examine how state and companies are making industry to meet the developmentalist goals of an Ethiopian ruling party and the needs of capital, respectively, albeit not without local collaboration and resistance.

This dissertation examines French and Francophone texts, contexts and thematic problems that comprise a genre I call "ethnographic fiction," whose development we can trace throughout the twentieth century in several geographic locations and in distinct historical moments. During the twentieth century in France, anthropology as an institutionalized discipline and "literature" (writ large) were in constant communication with one another. On the one hand, many French anthropologists produced stylized works demonstrating aesthetic sensibilities that were increasingly difficult to classify. On the other hand, though, poets, philosophers and other literary intellectuals read, absorbed, commented on and attacked texts from anthropology. This century-long conversation produced an interdisciplinary conceptual field allowing French anthropology to borrow from and adapt models from literature at the same time as literature asserted itself as more than just an artistic enterprise and, indeed, as one whose epistemological prerogative was to contribute to and enrich the understanding of humankind and its cultural processes. In this dissertation I argue that fiction can be seen to travel in multiple directions within France's twentieth-century conversation between literature and anthropology such that we can observe the formation of a new genre, one comprised of texts that either explicitly or more implicitly fuse fictional forms and contents together with the methodological and representational imperatives of anthropology and ethnographic fieldwork. Additionally, I argue that fiction moves geographically as well, notably from the metropole to Francophone West Africa which became an anthropological hotspot in the twentieth century once extended field research was legitimated in France and armchair anthropology was thoroughly discredited. By investigating ethnographies, novels, memoirs and films produced both in metropolitan France, Francophone West Africa, and the French Caribbean (including texts by Michel Leiris, Amadou Hampâté Bâ, Jean Rouch, Jean-Claude Izzo and Raphaël Confiant), I aim to shed light on the kinds of work that elements of fiction perform in ethnographic texts and, by contrast, on how ethnographic concepts, strategies and fieldwork methods are implicitly or explicitly adopted and reformulated in more literarily oriented works of fiction. Ethnographic fiction as a genre, then, was born not only from the epistemological rapprochement of anthropology and literature in metropolitan France, but from complex and often fraught encounters with the very locations where anthropological praxis was carried out.

This dissertation is a history of cosmopolitanism in the francophone, musical, and Islamic intellectual traditions of western Niger from 1958 to 1974. It builds on scholarship that seeks to counter conventional nationalist narratives of African decolonization by viewing it through an anti-teleological lens. While most of this literature focuses on the alternatives to the nation proposed by African leaders prior to independence, framing them as lost futures, this project argues that cosmopolitanism constituted a core state project of Niger’s francophone elite even after independence. Its account begins with this official cosmopolitanism of the PPN-RDA regime, most thoroughly articulated by Boubou Hama in the language of the civilization of the universal derived from Negritude. Drawing on sound studies and a wide variety of audio recordings in addition to period newspapers, films, and other primary sources, it also demonstrates the ways that this utopian cosmopolitanism in a repressive, one-party state was contested and undermined by intellectuals operating from both inside and outside the machinery of the state as well as the exuberant, unruly cosmopolitanism embedded in the radio soundscapes and film screens of Niger. From the traditional Sahelian cosmopolitanism transmitted in the epics of Zarma griots to the unworldly worldliness of vernacular Muslim poets and preachers, the dissertation paints a dynamic portrait of cosmopolitan imagination in modern Niger.

This dissertation explores the significance of Africa (both as a literal geographic space and as an imagined or symbolic space) in 19th century American intellectual and literary culture. I argue that when nineteenth-century intellectuals grappled with the institution of slavery, the significance of slave revolt, and the extent of black intellectual capacities, they dealt not only with a set of domestic social and political concerns, but also with a wider epistemological crisis surrounding the very idea of Africa and Africanness. The paradoxical legacy of the transatlantic slave trade, which produced unthinkable dislocation and suffering even as it created new diasporic networks of black affiliation built around a common African origin, forced a reexamination of conventional thinking about history, nationalism, cosmopolitanism, education, and civilization.

Diasporic Reasoning traces the impact of the idea of Africa on specific American intellectual outlets, including popular historiography, the novel, and the university. I contend that in each of these cases, the engagement with the idea of Africa enriches the possibilities of thought and leads to a fruitful reframing or refinement of established ideas, genres, and institutions. I begin with an exploration of the different historiographic uses of "representative men" in Ralph Waldo Emerson's Representative Men and William Wells Brown's The Black Man (Chapter One). I argue that Brown's contribution to the genre of collective biography complicates the apparent "universalism" of Emerson's earlier text, and forces us to rethink the categories of the universal and the particular. In Chapter Two, I continue to examine the impact of the African diaspora upon historical consciousness by arguing that the encounter with the specter of slave insurrection produces cognitive (and in turn, formal) ruptures in two historical novels, Herman Melville's Benito Cereno and George Washington Cable's The Grandissimes. Chapter Three focuses not on a literary genre, but on the circulation of knowledge through the institution of the modern university. Building from a comparative reading of the educational philosophies of Ralph Waldo Emerson and Edward Wilmot Blyden, I argue that Blyden's provocative conception of an "African university" draws out and extends upon the implications of Emerson's thinking on education. Finally, in the Epilogue, I look at the syncretic uses of "Ethiopianism" in Pauline Hopkins' Of One Blood, J. A. Casely Hayford's Ethiopia Unbound, and W. E. B. Du Bois' Darkwater in order to explore the new paths that Pan-African and diasporic thought would take in the twentieth century. I argue that these works reflect the degree to which an evolving anthropological understanding of the idea of "culture" and the specific political contexts of anti-colonial struggles across the African continent would complicate the kinds of intertextual possibility available in the nineteenth century. This dissertation thus traces the often-surprising intellectual interrelations of America and the African diaspora, and in so doing, opens up a more nuanced approach to the study of nineteenth-century literary and intellectual culture.

This dissertation examines photographic representations of Ethiopian identity. It focuses on Emperor Haile Selassie I as a recuperative figure in Pan-African contexts, images by court photographer and later London studio portraitist Shemelis Desta, and contemporary works created by Ethiopian artists in the diaspora one generation after the Derg’s collapse. Exploring visual processes that concern, inform, and confront the practices of photographers working at the intersection of ethnic identity and nationalism, this dissertation scrutinizes Ethiopian artists’ views of the importance of their work to their country and to the African diaspora in conjunction with opposing historical narratives adopted by Black nationalists, and alternatively, white imperialists in the early twentieth century.

Background/ObjectivesAfrica has only 1% of the global neurosurgery workforce, despite having 14% of the global population and 15% of the global neurosurgical disease burden. Also, neurosurgical training is hampered by paucity of training institutions, dearth of training faculty, and deficiency of optimal training resources. The study appraises the current specialist neurosurgical workforce in Africa, evaluates the major neurosurgery training programs, and projects the 2030 workforce capacity using current growth trends. Methods The study involved systematic and gray literature search, with quantitative analysis of retrospective data on the neurosurgery workforce, qualitative evaluation of the major neurosurgery training programs for their strength, weaknesses, opportunities, and threats, and projection modeling of the workforce capacity up to year 2030. Results 1,974 neurosurgeons serve 1.3 billion people (density 0.15/100,000; ratio 1:678,740), in Africa, with the majority (1,271; 64.39%) in North Africa. There are 106 specialist neurosurgery training institutions in 26 African countries, with North Africa having 52 (49.05%) of the training centers. Training is heterogenous, with the major programs being the West African College of Surgeons (WACS) - 24 centers across 7 countries, and the College of Surgeons of East, Central and Southern Africa (COSECSA) - 17 centers in 8 countries. At the current linear growth rate of 74.2 neurosurgeons/year or exponential growth rate of 6.81% per annum, Africa will have 2,716 - 3,813 neurosurgeons by 2030, with a deficit of 4,795 - 11,953 neurosurgeons. The continent requires a scale-up of its linear growth rate to 663.4 - 1269.5 neurosurgeons/year, or exponential growth rate to 15.87% - 22.21% per annum to meet its needs. While North African countries will likely meet their 2030 workforce requirements, sub-Saharan African countries will have significant workforce deficits. Conclusion Despite a recent surge in neurosurgery residency training, the current state of Africa’s neurosurgery workforce is dire, and many countries will be unable to meet their workforce requirements by 2030 at current growth trends. A significant scale-up of the neurosurgery workforce is required in order to meet these targets.

The needs of South African men with HIV are often overlooked in providing healthcare for people living with HIV/AIDS, leading to unique needs and experiences for men seeking HIV/AIDS healthcare. Compounding this phenomenon are norms of masculinity guiding these men's behaviors as they navigate health and healthcare systems. The aim of this study is to provide new insight on which components of masculinity interplay with healthcare access in South Africa. The study took place at one primary health care clinic in a peri-urban township in rural KwaZulu-Natal, South Africa. In-depth individual interviews were conducted with 21 HIV-positive men recruited from the clinic. Direct observations of the HIV clinic waiting area were also conducted. Data was analyzed using a grounded theory-informed memo-writing approach. Participants expressed a range of ways in which masculine ideals and identity both promoted and inhibited their willingness and ability to engage in HIV care. Notions of masculinity and social identity were often directly tied to behaviors influencing care engagement. Such engagement fostered the reshaping of identity around a novel sense of clinic advocacy in the face of HIV. Our findings suggested that masculinities are complex, and are subject to changes and reprioritization in the context of HIV. Interventions focusing on reframing hegemonic masculinities and initiating treatment early may have success in bringing more men to the clinic.

There is little information regarding the knowledge, attitudes and practices of obstetric care providers in Rwanda, who are a crucial component for providing quality Safe Motherhood care. Despite investments in the structural capacity needed to deliver these services, little has been directed towards understanding the current competency of skilled providers on the front lines of maternal mortality and morbidity prevention. This study surveyed 87% of all obstetric care providers in the Bugesera District of Rwanda to determine their demographic characteristics, competency in Safe Motherhood knowledge, obstetric practices, and attitudes towards patients and training approaches. The study identified the majority of providers to be A2 level nurses (82%) who have received one year of health education in secondary school. In addition, the majority of providers expressed that both their knowledge (60.6%) and skills confidence (72.2%) across fundamental topics of Safe Motherhood care need improvement. There was a low level of demonstrated knowledge in Safe Motherhood services with a mean of 46.4% of 50 questions answered correctly. Performance of knowledge in normal labor (39.3% correct) and obstetric complications (37.1% correct) were the weakest areas identified. A high percentage of providers (60.8%) engage in the potentially harmful practice of fundal pressure during vaginal delivery, while only 15.9% of providers practice steps of the active management of the third stage of labor in 100% of their deliveries. Providers view additional education and training in emergency obstetric care (EMOC) to be very useful, with 89.3% reporting an enthusiastic willingness for participation in a two-day workshop even if it was their day off. Improving knowledge, skills and practices of obstetric providers is an essential step in improving the quality of emergency obstetric care.

This multi-sited (or “patchwork”) ethnography (A.L. Tsing 2011, xi; Günel, Varma, and Watanabe 2020; Marcus 1995; A.L. Tsing 2015) examines how Mande music is remade in its circulation through world music industry networks of the Black Atlantic. I study how world music record producers work to reconcile ethical, aesthetic, and financial motivations in sound. Turning to Toumani Diabaté’s Kaira (1988), an influential world music album produced by ethnomusicologist Lucy Durán, I argue that this recording has been uniquely consequential in defining the sound of Mande music for Global North publics, and then I treat it as a case study to consider the ethics of cross-cultural record production. I show how Durán engages with a politics of invisibility to prioritize the careers of her collaborators, to cultivate ethnographic authority in her recording practice, and to create avenues for broad public appreciation of Mande music traditions, even as she effects alterations on the musical practices she proposes to reflect. Next, I illustrate how one Mande musician’s expressive practice is transformed by his migration to the Southern United States and by his interactions with the music industry in that context. Finally, I present a sonic exposition of twenty-six Mande music recordings that I myself produced as yet another frame in which to consider how Mande music is remade in circulation.

This dissertation considers the production of video films by Nàgó–Yorùbá creators along Bénin’s southeastern border with Nigeria. There they find themselves at the margins of three better-funded arts industries with contrasting attitudes toward Nàgó–Yorùbá culture and aesthetics. In Nigeria, much of the Nollywood video film industry supports belonging to global religious movements, such as Pentecostal Christianity and Reformist Islam, all the while portraying indigenous religion as diabolical. The art-film scene of Bénin often dismisses West African video films as amateurish. Finally, Bénin’s state arts programs promote the Vodun religion of the coast as a tourist attraction yet deny Nàgó–Yorùbá people compensation for the state’s appropriation of their religious arts into the category of “Vodun.” Against this backdrop, video filmmakers use movies to celebrate indigenous religion and culture, to promote religious ecumenism, and to seek new sources of material support. Nevertheless, Nigerian media saturates the marketplace in Bénin so that very few local video films can earn a profit. My study thus seeks to determine how Nàgó–Yorùbá media practitioners persist in the face of such precarious conditions. I ask how the production of media becomes a forum to debate and establish norms of community and religious practice, how national identity, religious affiliation, and professional prestige affect negotiations over religious attitudes and conceptions of community, and how the open style of production in Bénin allows a diverse group of people—media professionals and others—to participate in the debates and discussions that shape media projects.

My work is based on twenty-two months of ethnographic fieldwork at the Bénin–Nigeria border. During this time, I learned moviemaking from video filmmakers directly, acting in their productions, learning camerawork and editing, and eventually producing my own video film. I argue that Nàgó–Yorùbá video filmmakers make video movies because doing so is a community-sustaining endeavor. These efforts grant video filmmakers a prominent status in their communities as recognizable and relatable faces, and as the conveners of social activities on sets and in studios where they mingle and discuss productions with colleagues and audience members. This intimacy turns video filmmaking into what I call a production public, a group whose activities not only create media, but also negotiate the audiovisual aesthetics by which religion and culture are shown on screen. In the face of disappearing profits and intense competition, their activities are precarious, but as long as this public continues to make media, video filmmakers assume the role of moral authorities in the community while working with audiences and patrons to shape attitudes toward religious ecumenism, morality, and ethical engagement with regional and global forces. The public crafts an image of ideal community behavior that supports indigenous Nàgó–Yorùbá religion, rejects religious strife, and looks for ways to export its moral outlook to others.

With its description of God as wrathful and vengeful and its graphic depiction of war and violence, Nahum has often been treated as a dangerous book, both in church settings and in academic circles. This dissertation is an effort to confront violence, both in my community and in the book of Nahum. It is a contextual reading of Nahum against the background of the wars that have plagued my country, the Democratic Republic of the Congo since the early 1990s. It argues that Nahum’s description of God and its depiction of war scenes were meant to evoke in seventh-century BCE Judahite audiences the memory of war and destruction at the hands of the Assyrians. The vivid images of YHWH’s war against Nineveh do not give readers a historical report on the fall of Nineveh, neither do they intend to foreshadow the historical fall of that Neo-Assyrian capital city in 612 BCE. Rather, they more likely reflect the prophet-poet’s attempt to depict a world that would have spoken to the painful collective memory of those who survived the destruction of Lachish and other Judahite towns during Sennacherib’s invasion of Judah in 701 BCE. The prophet uses lyric poetry to evoke (rather than narrate) Judah’s memory of war and reveal the immediate and comforting presence of YHWH within the conditions of war. He presents that revelation by adapting two traditional literary forms, the biblical Oracle against foreign Nations (OAN) and the Ancient Near Eastern city lament. Given the rhetoric of the book within its early audience, I show that this book can also speak powerfully into the conditions of Congolese Christians who have suffered the trauma of war.

Up to two million women worldwide have obstetric fistula, a maternal morbidity prevalent in developing countries that causes uncontrollable leaking of urine and/or feces and a persistent bad odor. There is both theoretical and empirical evidence for psychopathology in patients presenting for fistula surgery, albeit with methodological limitations. The current studies sought to improve on past limitations of study design. Study A compared psychological symptoms and social support between fistula patients and a comparison group recruited from gynecology outpatient clinics. Measures included previously validated psychometric questionnaires, administered orally by data collectors. Results showed that compared to gynecology outpatients, fistula patients had significantly higher levels of depression, traumatic stress, somatic symptoms and avoidant coping, and had lower social support. Study B investigated changes in psychological symptoms, stigma and social support between the time of admission for fistula repair and 3 months after discharge from the hospital. At follow-up, fistula patients reported significant improvements in all study outcome variables. Exploratory analysis revealed that the extent of leaking was associated with depression and PTSD. These results indicate the potential benefit of mental health interventions for this population. Additionally, future research may clarify the relationship between residual leaking after fistula surgery, and its effect on post-surgery mental health outcomes.

This dissertation focuses on raiding and sovereignty in the Central African Republic's (CAR) northeastern borderlands, on the margins of Darfur. A vast literature on social evolution has assumed the inevitability of centralization. But these borderlands show that centralization does not always occur. Never claimed by any centralizing forces, the area has instead long been used as a reservoir of resources by neighboring areas' militarized entrepreneurs, who seek this forest-savanna's goods. The raiders seize resources but also govern. The dynamics of this zone, much of it a place anthropologists used to refer to as "stateless," suggest a re-thinking of the modalities of sovereignty. The dissertation proposes conceptualizing sovereignty not as a totalizing, territorialized political order but rather through its constituent governing capabilities, which may centralize or not, and can combine to create hybrid political systems. The dissertation develops this framework through analysis of three categories of men-in-arms -- road-blockers, anti-poaching militiamen, and members of rebel groups -- and their relationships with international peacebuilding initiatives. It compares roadblocks and "road cutting" (robbery) to show how they stop traffic and create flexible, personalized entitlements to profit for those who operate them. The dissertation also probes the politics of militarized conservation: in a low-level war that has lasted for twenty-five years, the European Union-funded militiamen fight deadly battles against herders and hunters. Though ostensibly fought to protect CAR's "national patrimony" (its animals and plants), this war bolsters the sovereign capabilities of a range of non-state actors and has resulted in hundreds of deaths in the last few years, many of them hidden in the bush. The dissertation then shows how CAR's recent cycle of rebellion has changed governance in rural areas. Though mobile armed groups have long operated in CAR, they used to work as road cutters and local defense forces and only recently started calling themselves "rebels" -- a move that has landed them in new roles as "governors" of populations while leaving them without the welfare largess they seek. Throughout these various raiders' projects, the idea of the all-powerful state serves as a reference point they use to qualify themselves with sovereign authorities. But their actions as rulers undermine the creation of the unitary political authority they desire and invoke. Failure to appreciate these non-centralized micropolitical processes is a main reason peacebuilding efforts (such as disarmament, demobilization, and reintegration) in the region have failed.

Perhaps second only to coffee, Ethiopia is best known worldwide for its long-distance runners. Since the 1960s, the country has indeed won countless Olympic medals and major marathons. However, the persisting explanatory rhetoric for East African running dominance relies on deterministic understandings of race, genetics, and environment. Little attention has been paid to the dimensions of labor, culture, and gender at work. This dissertation is the first in-depth ethnographic study of young Ethiopian women seeking a career in long distance running.

Based on two years of fieldwork in Addis Ababa and surrounding areas, domestic trips to competitions and training camps around Ethiopia, an internship at an international sports agency based in West Chester, Pennsylvania, and travel to competitions around the world, the dissertation investigates the transnational networks of people and corporations that female runners move within and across as they navigate a global athletics market. Foregrounding gender, body politics, and global capitalism, my project revises the biology-centered concept of “running economy” into a multi-faceted sociocultural analytic for exploring how aspiring runners strive to make monetary value. How, I ask, can we look at running economy more holistically?

In underlining the social and cultural dimensions of running economy and centering the perspectives of women who exist within the transnational economy of running, we can see how Ethiopian women contest commonsense understandings of how this global athletics economy functions – and make their own moral judgements about what a more just economy would look like. Even as some of them drastically improve their lives by running, and remain hopeful while reaching for success, they find ways to cause frictions and disrupt hegemonic flows of ideas and money. By listening to how they politicize their training as labor, and by hearing their demands and desires, I argue that Ethiopian women runners expose many of the failed opportunities that capitalist structures and ideology espouse and urge us to rethink how we could better structure transnational economies.

The dissertation considers how young people in northern Uganda navigate post-conflict life through participant observation, interviews, and ethnographic focus groups with youth working as security guards, current and formerly incarcerated youth, and young people seeking employment in South Sudan. It offers a detailed, sustained view into the everyday practices young people undertake to envision a future after prolonged civil conflict despite intense social, political, and economic constraints. I worked extensively with individuals who occupied different positions of vulnerability and security in order to investigate how these categories overlapped and intertwined in their daily lives. By doing so, the research makes broader interventions into theories of youth and of post-conflict recovery including how individuals encounter post-war legal authority, how humanitarian interventions impact intergenerational and familial relationships, and what strategies young people employ when the resources and opportunities afforded to them through the expansive humanitarian network that once surrounded them leaves the region, or transforms into something else entirely. I argue that the constraints young people face, coupled with the state’s attempt to securitize them as a potentially destabilizing political and economic force, generate impossible predicaments which often require them to take on increasingly dangerous risks, which in turn open them up to further securitization in a cycle that leaves young people unable to build anything but fraught futures despite being the future of the nation. A central aim of my research was to destabilize the "post" in post-conflict, not only to point to the ways in which conflict has afterlives (which is well treaded territory in anthropology) but also to disrupt the clean temporality the term presumes. I argue that young people do not take the “post” as a new dawn from which to build possibility, but instead draw on their past experiences to make sense of the present despite the uncertainty of the future. Building on other recent scholarship, my research interrogates the durability of the "post" as a way of opening up pathways which young people (and others) draw on to make sense of their daily lives.

“Spaces of Order” argues that the African novel should be studied as a revolutionary form characterized by aesthetic innovations that are not comprehensible in terms of the novel’s European archive of forms. It does this by mapping an African spatial order that undermines the spatial problematic at the formal and ideological core of the novel—the split between a private, subjective interior, and an abstract, impersonal outside. The project opens with an examination of spatial fragmentation as figured in the “endless forest” of Amos Tutuola’s The Palmwine Drinkard (1952). The second chapter studies Chinua Achebe’s Things Fall Apart (1958) as a fictional world built around a peculiar category of space, the “evil forest,” which constitutes an African principle of order and modality of power. Chapter three returns to Tutuola via Ben Okri’s The Famished Road (1991) and shows how the dispersal of fragmentary spaces of exclusion and terror within the colonial African city helps us conceive of political imaginaries outside the nation and other forms of liberal political communities. The fourth chapter shows Nnedi Okorafor—in her 2014 science-fiction novel Lagoon—rewriting Things Fall Apart as an alien-encounter narrative in which Africa is center-stage of a planetary, multi-species drama. Spaces of Order is a study of the African novel as a new logic of world making altogether.

Since the end of the Cold War, natural resources have assumed an increasingly prominent role in security, conflict, and peace studies. Scholars and development practitioners alike view the development of strong institutions, which aim to domesticate global regulatory regimes that foster neoliberal principles like privatization, transparency, and accountability, as necessary to mitigate natural resource conflict in resource-rich states, as well as enhance opportunities for peace and social justice. However, the application of environmental peacebuilding theory to resource-rich contexts has outpaced the ability of empirical research to substantiate its claims, and scholars remain unclear about the mechanisms by which institutional reforms minimize conflict risk or promote peace. This dissertation examines the extent to which the diffusion and uptake of global environmental governance standards has (re)shaped the politics of mineral extraction in Ghana and Sierra Leone. I explore claims that social and environmental outcomes have deteriorated amid efforts by Ghana and Sierra Leone to build regulatory capacity. Using interview, survey, and ethnographic data collected across multiple scales in Ghana and Sierra Leone between 2014 and 2016, I find that while governance reforms have produced strong environmental regulatory institutions in both contexts, these institutions have failed to drive wider social and environmental change within society. Rather, institutional reforms have contributed to patterns of development that undermine state-society relations, and reinforced conditions that promote institutional plurality on the ground. The state remains only one of several options for obtaining legitimate access to mineral resources, meaning that multiple and conflicting sets of “rules-in-use” govern extraction. This perpetuates what I term a “hollow state” in which formal state institutions are continually eroded by informal bottom-up processes. The resulting institutional terrain has produced conditions in which plural authoritative networks compete for social influence as well as access to and control of natural resources. This, in turn, has contributed to chronic, low-intensity conflict, environmental degradation, and the pursuit of elite interests and power at the expense of sustainable resource extraction and livelihood security. Overall, this research suggests a need for environmental peacebuilding theory to reconceptualize linkages between environment, development, and social stability in resource-rich states.

Background: Globally, hypertension affects one billion people and disproportionately impacts the developing world. Sub-Saharan Africa has a high prevalence of hypertension with a low rate of awareness and compliance with treatment. The current model of community-based screening does not always ensure follow-up for treatment initiation. In high-income countries, emergency department (ED)-based screening has been successful at capturing undiagnosed/uncontrolled hypertension cases.

Methods: Between July 2017 and March 2018 we conducted a prospective cohort study of hypertensive patients in the emergency department of Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Adults patients with a triage blood pressure > 140/90 were recruited, completed a demographic and knowledge, attitudes and practices (KAP) survey and were followed for one month. Hypertension was defined as a single blood pressure ≥ 160/100 mmHg or a three-time average of ≥ 140/90 mmHg. Successful follow-up was defined as seeing a medical doctor within one month of the ED visit. Basic demographics were performed and to investigate relationships with potential risk factors and failure to follow-up, generalized linear models were used.

Results: We enrolled 595 adults (mean age 59.6) including 175 men (39.2%) and 271 women (60.7%). Of the 600 patients enrolled, 590 (99%) meet our definition for hypertension. Overall, the prevalence of hypertension was 10.3 % (95% CI 9.5,11.0) and 303 (56.2%) of participants failed to follow-up with a primary care physician within 1 month of the ED visit. Successful follow-up was independently associated with understanding that hypertension requires lifelong treatment (RR 1.11; 95% CI 1.03,1.21) and inversely associated with being worried about a future with hypertension (RR 0.80; 95% CI .64,1.00). The majority (78.6%) of the participants were aware of their disease, but many 223 (37.2%) had uncontrolled hypertension and 265 (44%) had evidence of end-organ damage.

Conclusion: The emergency department in Moshi Tanzania experiences a high burden of hypertensive patients, the majority of which fail to follow-up within one month of the ED visit. Multi-disciplinary strategies should be employed to improve linkage to care for high-risk patients from the emergency department.

This dissertation examines the recent influx of Pentecostal-charismatic churches into the Northern Region of Ghana, a rural, underdeveloped region whose predominantly Muslim population has increasingly become the target of evangelistic efforts undertaken by Christians from the south. Based on ethnographic and archival research, my study considers the locus of this incursion as a densely layered zone of anxieties and emergences, desires and contestations, in which the elaboration of novel horizons of sensibility and experience is refracted through the vicissitudes of the region's social, economic, religious, and political history. I argue that the churches' impassioned campaign to "take back the north for the Lord" - a campaign whose exemplary medium is the evangelistic crusade in which "signs and wonders" are mobilized as particularly potent technologies of conversion - demarcates a complex field of intervention animated by a plurality of forces irreducible to those of strictly religious provenance. An ethos of progress and success fostered by the country's development apparatus; the longstanding prejudices surrounding northerners and "the north" in the Ghanaian national imaginary; the specter of a Muslim threat that surfaces in a post-9/11 world and perpetuates amidst a global war on terror - these are among the contingencies that have come together to render this encounter possible. Yet, far from simply overlaying these historical-political logics with the veneer of Christian discourse, my work charts the dissemination of a faith whereby, through the indwelling of the Holy Spirit, converts are anointed with a power to conceive themselves and, by extension, the world as nothing less than a totally "new creation." I contend that such practices of salvation, so characteristic of Pentecostalism's proliferation across the continent as a whole, are being recast in ways both subtle and sensational by their transposition into the allegedly pathological space of northern Ghana - as are, I suggest, the lives of the men and women who inhabit it.