A multi-sited, following approach: A means to study antimicrobial use and resistance as problems of connection

Surf the net, survey popular media, read scientific publications, drink bottled water, go to a conference, swim in the river: antimicrobials and resistant microbes are reported to be everywhere, literally! Maybe even in space! Like many microbiologists and other scientists, we anthropologists, as well as other social and humanities scholars more broadly, are increasingly interested in how this has come to be and what effective actions can be taken.

Together with universities, human societies, bacteria and the planet we live on, anthropology has undergone many changes over the last century. Initially, anthropologist (European and North Americans) travelled to settings unfamiliar to them, often abroad, to document the lives of a particular group of people or society. They spent extended periods of time (typically a year or more) conducting ethnography, including learning local languages, observing and participating in their daily lives and celebrations, so as to create ‘holistic’ accounts of what they observed and participated in. Geographically, these anthropologists delimited their fieldwork to places where the people they studied lived, farmed, hunted and travelled. This approach presupposed that these people were isolated or that any relations they might have with people beyond their societies were irrelevant to understanding them. However, with increasing quantity and speed of human and nonhuman movement, greater recognition of the legacies of colonialism and globalisation, and pressures on their time, anthropologists adapted their methodologies in order to study phenomena that unfold across multiple sites.

Multi-sited fieldwork has provided a means for researchers to understand and document global or trans-local phenomena by following people, things and ideas  – sugar, salmon, mushrooms, migrants and medicines, to name just a few – across different materials and settings, whether as part the world-system (multi-sited ethnography), globe (global ethnography) or different realities (science and technology studies and anthropology of global health). Such approaches are significantly at odds with those that produce the now common accusations in journals, media and policy-circles of ‘indiscriminate’, ‘excessive’ and ‘irrational’ antimicrobial use. These publications often focus on settings (ignoring connections between countries or sectors) or individuals in isolation and/or blackboxing the specifics and quantities of antimicrobial use from other relevant issues, like equitable access to services and economic inequalities. A following, multi-sited approach goes beyond reductionist studies of antimicrobial use and offers a means to explore AMR as a problem of connections that takes these kinds of issues (e.g. inequalities and inequities) as seriously as resistance itself.

For example, a researcher might follow antibiotics through supply chains from manufacturing to sale point, consumption, and even expulsion in the form of residues. Or they might attempt to trace the origins of mass bacterial resistance to specific antibiotics, institutional forms, social practices, ways of living and working (see the work of Landeckerand Kirchhelle). Studying antibiotics in this way can potentially allow accusations of ‘misuse’ to be evaluated in relation to the settings, activities and immediate needs of people they are connected with, and thus shed light on their multiple roles (i.e. as commodities, technologies and symbols of care, growth promoters, quick fixes, pollutants). However, it also opens up necessary space to explore why they have come to be used in such quantity and frequency in the first place and to question the ethical, social, political, economic and ecological implications of these other rationales (e.g. increased consumption, production and profits, poor hygiene etc). To explore these topics requires the researcher to work, often in teams, across different sites and materials, including: reading policy and scientific documents, visiting microbiology laboratories, pharmaceutical factories and markets, attending meetings and conferences.  A failure to understand and engage with the diversity of roles, activities, people, animals, plants and settings that antimicrobials are connected with, risks not only ineffective translation of global and national policies into local action, but also many unintended and potentially damaging consequences. Research that engages with following across different sites, can offer much to respond to this need to better understand and address antimicrobial use and AMR in nuanced, culturally and contextually sensitive manners, while balancing and juxtaposing them with relation to specific, global and future concerns of AMR.

Works Cited

1. Burawoy M, Blum JA, George S, Gille Z, Thayer M. Global ethnography: Forces, connections, and imaginations in a postmodern world. Univ of California Press; 2000.
2. Kirchhelle C. Pharming animals: a global history of antibiotics in food production (1935–2017). Palgrave Communications. 2018 [cited 2018 Dec 18];4(1):96. Available from: https://www.nature.com/articles/s41599-018-0152-2
3. Landecker H. Antimicrobials Before Antibiotics: A Short History of War, Peace, and Disinfectants. Palgrave Communications. 2018;4(1).
4. Lapegna P. Ethnographers of the World United? Current Debates on the Ethnographic Study of Globalization. Journal of World-Systems Research. 2009 Feb 26 [cited 2019 Feb 6];15(1):3–24. Available from: http://jwsr.pitt.edu/ojs/index.php/jwsr/article/view/336
5. Marcus GE. Multi-sited ethnography: Five or six things I know about it now. In: Multi-sited ethnography. Routledge; 2012. p. 24–40.
6. Yates‐Doerr E. Whose Global, Which Health? Unsettling Collaboration with Careful Equivocation. American Anthropologist. 2019;121(2):297–310. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/aman.13259

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