“Children as Caregivers: The Global Fight against Tuberculosis and HIV in Zambia by Jean Hunleth is a major contribution to our understanding of how children conceptualize illness as well as negotiate and manage the roles, responsibilities and risks they take on as caregivers in difficult and adverse situations. These are issues that children and families confront in both national and international settings but researchers have only recently begun to address them. Hunleth’s research is a model for how this field should move forward. Her ethnography is based on 18 months of research focused on children living in 25 households in a poor residential area—known as George—located on the outskirts of the capital city of Lusaka in Zambia. At the time of her research George had one of the highest TB rates in the country.
In seven richly detailed chapters (and one postscript) we are introduced to the children, their families and the larger community of George and we also learn about the changing TB treatment practices regulated by multiple national and international organizations (such as the World Health Organization). The focus throughout the book, however, is on the children’s everyday interactions and relationships within their households and immediate surroundings. Instead of viewing children as passive bystanders to the medical interventions employed to treat an infectious disease like TB, in Hunleth’s ethnography we see how children actively participate in these settings and draw on global health, humanitarian and biomedical systems of knowledge to construct their own understanding of an illness like TB. Most importantly we see how these ideas influence the way children act as caregivers to a family member who is ill and their strong desire to “be closer” to this person as a way of cultivating relationships, fostering interdependencies and maintaining a sense of normality in their own life as well as the life of their relative.
As a researcher with a long-standing interest in the “anthropology of children and childhood” I am particularly impressed with the approach that Hunleth developed and implemented for working with children in this context, especially the attention paid to children’s drawings along with the development of role-playing workshops and her innovative use of child-led audio recordings. This is an approach that wisely views children as research collaborators (rather than as research subjects) while at the same time situating their experiences and participation within the context of a household whose activities are structured by its gender and generational composition as well as by wider economic, social and political factors. Jean’s study has produced a number of important findings about how children take on illness management roles in urban settings such as George and it also raises some provocative ethical questions about the meaning of disclosure and confidentiality in the context of international public health studies.
Children as Caregivers makes important contributions to a number of fields, including medical anthropology, global health, human rights studies, household research in Africa and the anthropology of children and childhoods. It would be a perfect text for a range of courses on topics such as Socialization and Child Development, Global Health Practices, Human Rights Studies and African Studies. The research reported in this book could not be more important or more timely given the way that HIV related illnesses, such as TB, are changing and challenging traditional expectations about the roles and responsibilities of women, men and, especially, children in urban households in Zambia and elsewhere in Africa and around the world. This is a must-read book for anyone concerned with these issues!”
– Helen B. Schwartzman, PhD, Professor Emerita of Anthropology, Northwestern University (Reviewed February 21, 2017)