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The tyranny of empty shelves: Scarcity and the political manufacture of antiretroviral stock‐outs in South Kivu, the Democratic Republic of the Congo
Author(s) -
Taylor Stephen
Publication year - 2020
Publication title -
transactions of the institute of british geographers
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.196
H-Index - 107
eISSN - 1475-5661
pISSN - 0020-2754
DOI - 10.1111/tran.12365
Subject(s) - scarcity , denial , stock (firearms) , politics , democracy , geopolitics , framing (construction) , development economics , gambit , economic growth , political economy , sociology , economics , political science , geography , market economy , law , psychology , archaeology , psychoanalysis , fluent , computer simulation , engineering , simulation
At the margins of the global scale‐up of antiretroviral treatment for HIV, the Democratic Republic of the Congo has experienced severe regional stock‐outs of essential medicines. Usually framed by global health actors as signs of technical, logistical, and professional deficiency, antiretroviral scarcity is – perhaps surprisingly – rarely considered to be an exceptional event. Attention to the local consequences of scarcity in the east of the country, however, suggests that stock‐outs arise from far more than mere infrastructural failings. Drawing on an investigative ethnography conducted in the province of South Kivu between 2016 and 2018, this paper examines how stock‐outs in the region have political functions rooted in the calculated denial of medicine to geopolitically significant communities and individuals. Informed by extant research on the geopolitics of health, I begin by conceptually framing the geographical significance of stock‐outs and locate in their origins and functions the discriminate use of scarcity as a biopolitical tool. Then, drawing on interviews and the analysis of previously unpublished and uncollated stock records, I demonstrate the technical and political origins of stock‐outs at six dispensaries in the province. The supply of essential medicines, I argue, has become weaponised and their denial represents a strategic gambit for armed actors seeking territorial footholds in the region. Focusing on the cases of two out‐of‐stock towns in the south of the province, I then examine patients′ agonising experiences of stock‐outs, the poisoning and distortion of local moral economies that scarcity gives rise to, and the profoundly ambiguous transformations of therapeutic citizenship birthed by denial of treatment. I conclude by returning to the scale‐up of antiretroviral treatment and review the critical avenues opened up for health geographers by a focus on the provisioning, scarcity, and denial of essential medicines.