Pluripotent trajectories: public oncology in Rwanda


This article examines how Rwandan patients understand and represent cancer, as well as how state actors articulate the agenda of public oncology and related expectations of citizens. Patients view cancer and infection as co-existent and processually intertwined. This elides with the reality of epidemiology on the ground, as the local burden of disease encompasses both infectious and noncommunicable diseases. Further, patients still consider the efficacy of occult acts in causing tumors, particularly in the face of a disease marked by etiological uncertainty in the biomedical realm, and frequent resistance to treatment. At the same time, both policy makers and clinicians servicing public oncology expect citizens to quickly relinquish any beliefs in the occult and fully embrace a biomedical value system. Beyond the fact that this project cannot be fulfilled, its articulation only limits the ability to envision a more capacious framing of oncology which acknowledges both the limits of treatment, and the diverse ways in which patients suffering from cancer make meaning in the face of grave illness.

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Change history

  • 24 July 2019

    In the original publication of the article, the Acknowledgments section was omitted. The acknowledgements section and the revised author’s biography are given in this Correction.


  1. 1.

    See Accessed March 27, 2019.

  2. 2.

    The Merriam-Webster Dictionary defines a boil as “a localized swelling and inflammation of the skin resulting from infection of a hair follicle and adjacent tissue, having a hard central core, and forming pus.” An abscess is “a localized collection of pus surrounded by inflamed tissue.”

  3. 3.

    In some instances, I offer both the singular and plural forms of Kinyarwanda nouns (singular/plural).

  4. 4.

    Examples of substances used are animal feathers, trees, or crushed powder from the bones of various animals.

  5. 5.

    The inauguration of Butaro Hospital took place in July of 2011. See the article “Rwanda: Clinton Hails Resilience of Cancer Patients.” Accessed March 27, 2019.


  1. Agosti, J.M., and S.J. Goldie. 2007. Introducing HPV vaccine in developing countries—Key challenges and issues. New England Journal of Medicine 356 (19): 1908–1910.

  2. Ashforth, A. 2005. Witchcraft, violence, and democracy in South Africa. Chicago: University of Chicago Press.

  3. Bilimoria, N.F. 2012. Lessons learned from a decade of partnership between PEPFAR and the Global Fund: A case study from Tanzania. Health Affairs (Project Hope) 31 (7): 1415–1421.

  4. Binagwaho, A., et al. 2014. Rwanda 20 years on: Investing in life. Lancet 384 (9940): 371–375.

  5. Brantlinger, P. 1985. Victorians and Africans: The genealogy of the myth of the dark continent. Critical Inquiry 12 (1): 166–203.

  6. Chary, A., and P. Rohloff (eds.). 2015. Privatization and the new medical pluralism: Shifting healthcare landscapes in Maya Guatemala. Lanham, Maryland: Lexington Books.

  7. Comaroff, J., and J.L. Comaroff. 1999. Occult economies and the violence of abstraction: Notes from the South African postcolony. American Ethnologist 26 (2): 279–303.

  8. Conrad, J., and R. Kimbrough. 1988. Heart of darkness: An authoritative text, backgrounds and sources, criticism, 3rd ed. New York: Norton.

  9. Coreil, J., and J.D. Mull (eds.). 1990. Anthropology and primary health care. Boulder: Westview Press.

  10. Craig, D. 2002. Familiar medicine: Everyday health knowledge and practice in today’s Vietnam. Honolulu: University of Hawaii Press.

  11. Evans-Pritchard, E.E. 1976. Witchcraft, oracles, and magic among the Azande Abridged with an introd. by Eva Gillies. Oxford: Clarendon Press.

  12. Farmer, P. 2006. AIDS and accusation: Haiti and the geography of blame updated with a new preface. Berkeley: University of California Press.

  13. Farmer, P. 2005. Pathologies of power: Health, human rights, and the new war on the poor: With a new preface by the author 2005 ed.. Berkeley: University of California Press.

  14. Farmer, P. 2003. The uses of Haiti, 2nd ed. Monroe, ME: Common Courage Press.

  15. Farmer, P.E., et al. 2013. Reduced premature mortality in Rwanda: Lessons from success. BMJ 346: f65.

  16. Geraghty, M.A. 2016. Genocide ideology, nation-building, counter-revolution: specters of the Rwandan Nation-State. Doctoral Dissertation. Chicago: University of Chicago.

  17. Geschiere, P. 1997. The modernity of witchcraft: politics and the occult in postcolonial Africa = Sorcellerie et politique en Afrique: la viande des autres, Charlottesville [Va.]: University Press of Virginia.

  18. Geschiere, P. 2013. Witchcraft, intimacy, and trust: Africa in comparison, Chicago. London: The University of Chicago Press.

  19. Gluckman, M. 1955. Custom and conflict in Africa. Oxford: Blackwell.

  20. Goldie, S.J., et al. 2005. Cost-effectiveness of cervical-cancer screening in five developing countries. The New England Journal of Medicine 353 (20): 2158–2168.

  21. Good, B. 1994. Medicine, rationality, and experience: An anthropological perspective. Cambridge: Cambridge University Press.

  22. Good, M.J. 1995. Cultural studies of biomedicine: An agenda for research. Social Science and Medicine 41 (4): 461–473.

  23. Higginson, J. 1997. From geographical pathology to environmental carcinogenesis: A historical reminiscence. Cancer Letters 117 (2): 133–142.

  24. Jain, S., and N. Zorzi. 2017. Investing for impact: The global fund approach to measurement of AIDS response. AIDS and Behavior 21 (Suppl 1): 91–100.

  25. Jain, S.S.L. 2013. Malignant: How cancer becomes us. Berkeley: University of California Press.

  26. Janzen, J.M. 1978. The quest for therapy in Lower Zaire. Berkeley: University of California Press.

  27. Janzen, J.M. 1987. Therapy management: Concept, reality, process. Medical Anthropology Quarterly 1 (1): 68–84.

  28. Keshavjee, S. 2014. Blind spot: How neoliberalism infiltrated global health. Oakland, CA: University of California Press.

  29. Langwick, S.A. 2011. Bodies, politics, and African healing: The matter of maladies in Tanzania. Bloomington: Indiana University Press.

  30. Leslie, C. 1980. Medical pluralism in world perspective [1]. Social Science & Medicine. Part B: Medical Anthropology 14 (4): 191–195.

  31. Leslie, C.M. (ed.). 1976. Asian medical systems: A comparative study. Berkeley: University of California Press.

  32. Lima, V.D., et al. 2013. Potential impact of the US President’s Emergency Plan for AIDS relief on the tuberculosis/HIV coepidemic in selected Sub-Saharan African countries. The Journal of Infectious Diseases 208 (12): 2075–2084.

  33. Livingston, J. 2012. Improvising medicine: An African oncology ward in an emerging cancer epidemic. Durham: Duke University Press.

  34. Lock, M.M., and V.-K. Nguyen. 2010. An anthropology of biomedicine, Chichester, West Sussex. Malden, MA: Wiley-Blackwell.

  35. Marsland, R., and R.J. Prince (eds.). 2014. Making and unmaking public health in Africa: Ethnographic and historical perspectives. Athens: Ohio University Press.

  36. Mbabazi, D. 2016. New partnership in cancer fight launched. The New Times, Rwanda.

  37. McNeil Jr, D.G. 2013. Prices cut for HPV cervical cancer vaccines for neediest. New York Times, 9 May.

  38. McPake, B., et al. 2011. Removing user fees: Learning from international experience to support the process. Health Policy and Planning 26 (suppl_2): ii104–ii117.

  39. Mendenhall, E., et al. 2017. Non-communicable disease syndemics: Poverty, depression, and diabetes among low-income populations. Lancet (London, England) 389 (10072): 951–963.

  40. Mulemi, B.A. 2017. Therapeutic eclecticism and cancer care in a Kenyan hospital ward. In African medical pluralism, ed. C.F. Sargent and W.C. Olsen. Bloomington and Indianapolis: Indiana University Press, p.

  41. Nsanzimana, S., et al. 2015. Improving health outcomes through concurrent HIV program scale-up and health system development in Rwanda: 20 years of experience. BMC Medicine 13 (1): 216.

  42. Olsen, W.C., and C.F. Sargent (eds.). 2017. African medical pluralism. Bloomington and Indianapolis: Indiana University Press.

  43. Partners In Health Cancer Care. Inshuti Mu Buzima.

  44. Pashigian, M.J. 2012. East, West, North, South: Medical pluralism and “suitable” medicine for infertility in contemporary Vietnam. In Southern medicine for Southern People: Vietnamese medicine in the making, ed. L. Monnais-Rousselot, C.M. Thompson, and A. Wahlberg. Newcastle upon Tyne: Cambridge Scholars Pub.

  45. Pearson, M. 2004. Issues paper: The case for abolition of user fees for primary health services. London: DFID Health Systems Resource Centre.

  46. Peer, N. 2015. The converging burdens of infectious and non-communicable diseases in rural-to-urban migrant Sub-Saharan African populations: A focus on HIV/AIDS, tuberculosis and cardio-metabolic diseases. Tropical Diseases, Travel Medicine and Vaccines 1: 6.

  47. Remais, J.V., et al. 2013. Convergence of non-communicable and infectious diseases in low- and middle-income countries. International Journal of Epidemiology 42 (1): 221–227.

  48. Republic of Rwanda, Ministry of Health. 2018. Fourth health sector strategic plan: July 2018–June 2024.

  49. Reubi, D., C. Herrick, and T. Brown. 2016. The politics of non-communicable diseases in the global South. Health & Place 39: 179–187.

  50. Rhine, K., et al. 2014. Medical anthropology in global Africa. Lawrence, KS: University of Kansas, Department of Anthropology.

  51. Rwanda Biomedical Center. 2017. Early screening emphasized as a sure way to lessen cancer related deaths.

  52. Smith, D.J. 2014. AIDS doesn’t show its face: Inequality, morality, and social change in Nigeria, Chicago. London: The University of Chicago Press.

  53. Taylor, C.C. 1992. Milk, honey, and money: Changing concepts in Rwandan healing. Washington: Smithsonian Institution Press.

  54. Tilley, H. 2011. Africa as a living laboratory: Empire, development, and the problem of scientific knowledge, 1870-1950. Chicago: University of Chicago Press.

  55. Tilley, H. 2016. Medicine, empires, and ethics in colonial Africa. AMA Journal of Ethics 18 (7): 743.

  56. Union for International Cancer Control. 2018. The State of Oncology in Rwanda: A conversation with the Minister of Health|WCD.

  57. Wailoo, K., et al. (eds.). 2010. Three shots at prevention: The HPV vaccine and the politics of medicine’s simple solutions. Baltimore, MD: Johns Hopkins University Press.

  58. Watney, S. 1989. Missionary positions: AIDS, ‘Africa’, and race. Critical Quarterly 31 (3): 45–62.

  59. Watson, S.I., et al. 2016. The impact of user fees on health services utilization and infectious disease diagnoses in Neno District, Malawi: A longitudinal, quasi-experimental study. BMC Health Services Research 16 (1): 595.

  60. Williams, A.O., International Agency for Research on Cancer & Organization of African Unity. 1984. Virus-associated cancers in Africa: Proceedings of a symposium, Lyon, France, New York: International Agency for Research on Cancer, Oxford University Press.

  61. Wilson, M.H. 1951. Witch beliefs and social structure. American Journal of Sociology 56 (4): 307–313.

  62. World Health Organization. 2018. Noncommunicable diseases (NCD) country profiles. Rwanda: WHO.

  63. World Health Organization. 2014. Noncommunicable diseases (NCD) country profiles. Rwanda: WHO.

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Correspondence to Darja Djordjevic.

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The research study received IRB approval from all pertinent institutions in the USA and Rwanda.

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Djordjevic, D. Pluripotent trajectories: public oncology in Rwanda. BioSocieties 14, 553–570 (2019) doi:10.1057/s41292-019-00160-w

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  • Cancer
  • Public oncology
  • Rwanda
  • Infectious diseases
  • Noncommunicable diseases
  • Occult forces