Shape changing, name changing and fluidity

Does shape changing and name changing necessarily go with disorganisation? Is it something that is to be avoided? Is the methodological difficulty a sign of difficulty in the real world? Does it suggest that objects and their contexts are best when they are fixed and definite? The case of alcoholic liver disease suggests that this might be so. There doesn’t seem to be much doubt that the condition would have been better treated and better enacted if the organisation

for after-care had been better integrated and more tightly structured, if people in the hospital had understood the remit of the Alcoholic Advice Centre a little more clearly, and if the broader and less bounded version of alcoholic liver disease had been more consistently enacted. Some such recognition is implicit in the words of the consultant who commissioned us to do the study:

I would like to work more closely and effectively with an alcohol strategy for this district.71

But caution is needed. This is because if shape – and name – changing were a problem here, then there may be other locations where this is not the case. For instance, Marianne de Laet and Annemarie Mol describe the development and diffusion of a particular technology, the Zimbabwe bush pump (de Laet and Mol 2000). As they tell it, the pump is simple and robust. It is widely used in the villages of Zimbabwe, where is has often replaced other less satisfac- tory sources of water that may have been polluted and distant. The pump is manufactured in Harare as a kit, which is then installed after the necessary digging and concreting, by the villagers themselves. The idea – enshrined in government policy – is that villagers should organise themselves into a collective to take responsibility for installing and maintaining the pump. So the pump, it turns out, is not just a matter of technical engineering – and the introduction of pure water – but it is also an instrument of social engineering. Pure water, a simple machine, and a community structure, it is a simultaneous intervention in nature, in technology and in society.

De Laet and Mol are interested in this pump because it is so successful. So why is this? Their argument shows that its success is related to shape changing. To describe this they talk of fluidity. 72The pump, they say, is a fluid technology. Thus, though all the pump-kits manufactured in Harare start out life with the same shape, as they are installed and maintained that uniformity tends to disappear. It disappears technically. As bits wear out or fall off they are replaced by local make-do. These, it turns out, often work just as well as the original broken part. Even the inventor of the pump, who travels to the villages from time to time to see what is happening to the pumps after they are installed, is sometimes surprised by the innovations devised by villagers to keep their pumps going. So uniformity disappears technically. But it also disappears socially. For instance, though government policy insists on the creation of a village collective to take responsibility for the pump, very often this doesn’t happen, and the pump is cared for by a few families, or in some other kind of shared arrangement. Finally, nature (if I may extend the definition of nature to include what will count as pure water) also turns out to be variable. Is the water from the pumps pure? The answer is, almost always. But what does this mean? Sometimes it means that the water is pure because it meets bacteriological standards: the E.Coli count is lower than the internationally agreed threshold. More often, however, in a country where most of the villages are far from the facilities of a bacteriological laboratory, it means that few villagers contract

water-borne diseases. (And there are instances where villagers are healthy even though the water fails the bacteriological tests.) ‘Pure water’ is also a variable commodity.

So why is the pump so successful? As I have noted above, de Laet and Mol are telling us that this is because it changes shape. It is, they say, a fluid technology. And it is its fluidity, the fact that it slips and slides from one village to the next, that explains the extent of its diffusion. It slips, slides, alters its shape – and its relevant context alters too. Indeed the implication is even stronger than this. It is that if the technology were rigid – if the manufacturer insisted that repairs be carried out using parts made in the factory in Harare, or the government enforced its policy about village collectives, or international bacteriological standards were the sole measure of water purity – then the pump would not be nearly as successful as it actually is. In short, it is fluidity, the capacity for shape changing and remaking its context, that is the key to its success.

The conclusion is that fluidity, shape changing, and indeed name changing are not problems in and of themselves. They may, of course, be problems. Perhaps this is the case for alcoholic liver disease in Waterside, though even this is not entirely clear. This is because the problem may be not that the object changes its shape and its name, but rather that the balance and the movement between the different objects and their contexts is unsatisfactory: because it isn’t sufficiently fluid. Thus the body-based and predominantly medically produced version of alcoholic liver disease in the consulting room and in the medical functions of the ward is surely appropriate under some circumstances. If a patient is dying, then what is required is a strong medical regime and a strong medical reality. But, if the patient has withdrawn from alcohol, then what is needed is more likely to be the alternative broader reality produced by a mix of medicine, psychiatry and social support. Which (in the name shifting I have discussed) has as much to do with alcoholism or substance abuse as alcoholic liver disease. The issue, then, is about the relations between different objects and their different contexts. A graphic way of making the point would be to say that the consultants and others caught up in the narrowly medical assemblage ‘ought’ to be much more interested in the broader medical- psychiatric-social reality of alcoholism – and the assemblage that crafts this

– than they actually are. And they ‘ought’ to be much more interested in how patients are shifted from the acute context of alcoholic poisoning in the ward to the process of support in the community. For that process, the displacement from one method assemblage to the next, ‘ought’ to be much easier, much more fluid, than it actually is.

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