Season 2, Episode 7: Thurka Sangaramoorthy on Immigration and Health

In this episode, Joseph Harris sits down with American University anthropologist Thurka Sangaramoorthy to discuss her work on immigration and health. They talk about her work with Haitian immigrants in South Florida that was the subject of her first book; her work at the CDC and book on rapid ethnographic assessments; her new book - Landscapes of Care: Immigration and Health in Rural America on how immigrants navigate healthcare challenges in rural Maryland; the field of anthropology; and her recent experience working as Refugee Coordinator for the State Department's response in Sudan and South Sudan.  

Transcript

Global Health Politics Podcast

Season 2, Episode 7: Thurka Sangaramoorthy on Immigration and Health

SUMMARY KEYWORDS

global health, HIV care, immigrant health, anthropology research, public health, structural violence, Haitian immigrants, rural health, refugee coordinator, Sudan crisis, rapid ethnographic assessments, health disparities, climate crisis, interdisciplinary methods, research impact

Joseph Harris  00:00

Welcome to the Global Health Politics Podcast, where we go beyond the articles and books and have real intimate conversations with people working in the field of global health today,

Joseph Harris  00:18

I'm your host, Joseph Harris.

Joseph Harris  00:30

Today I'm really pleased to be here with Dr. Thurka Sangaramoorthy. Dr. Sangaramoorthy is a professor of anthropology at American University whose research has explored how to improve care for people living with HIV and how we can develop more effective care for non-citizen immigrants. Her latest book - Landscapes of Care: Immigration and Health in Rural America - examine how immigrants from Latin America and the Caribbean navigate the U.S. healthcare system. She's also recently served as Refugee Coordinator for the State Department's response in Sudan and South Sudan, working at the US Embassy in Addis Ababa. Welcome to the podcast. Thanks so much for being here, and congratulations on your latest book.

Thurka Sangaramoorthy  01:10

Thank you so much for having me. It's a great pleasure to be at BU.

Joseph Harris  01:14

So you studied two seemingly very different majors as an undergraduate in college, anthropology and biology. What ultimately led you to want to do a PhD in anthropology and focus on global health issues. 

Thurka Sangaramoorthy  01:27

Coming from a working class, immigrant, refugee family, I was always pushed into medicine. I think I realized in college I had a I didn't know what anthropology was. I took a course that was really topical and not disciplinary and really got hooked on anthropology. I felt like I was sort of studying my own life and what it was like growing up in the US. But I also really liked biology. I liked a lot of different things. I was actually going to become a primatologist, but I was of a generation where the four fields were going away, as I was in college, and the primatologists broke off and started doing more genetic focused things, and not necessarily animal behavior, which was the social sort of behavioral issues that I was really interested in. Medical anthropology seemed to encompass pretty much everything that I was interested in. It was still my intent to go to med school at some point, but I did have to work after college. I worked for a think tank. Like many people, I didn't know what to do with an anthropology degree. I worked for the think tank, Social Science Research Council. I worked for the Africa Program, and this was in the late 90s, where I spent a lot of time in Africa working on higher education, but it was also the height of HIV and of a certain generation of us that were very much drawn to the catastrophe that was happening and working in Africa. It was everywhere, and I wanted to do something right away. I couldn't imagine, like spending 10 years in school and medical school. So I came back and I thought public health was really the thing to study, to kind of go back and work on HIV in Africa. There was no global health as an official field back then. I studied maternal and child health, mostly in epidemiology, and I worked on a lot of great projects and studies, but I was really uncomfortable. There was this constant sort of tension that I had from my anthropology undergrad background. I didn't want to design programs in New York City where I was doing my public health degree, and then just go somewhere else and make sure that that got implemented. I was frustrated, and I thought: I really need additional training in anthropology. And so that's how I got to the PhD in anthropology. So I just kept going back and forth. But to me, they all connected somehow. Through primatology, I spent a lot of time watching animals.

Joseph Harris  04:11

So in your book - Treating AIDS - you examine the everyday practices of HIV/AIDS prevention in the US, from the perspective of AIDS experts and Haitian immigrants in South Florida. Could you give our listeners a sense of what that book is about? What motivated you to write it? 

Thurka Sangaramoorthy  04:29

So this was my PhD project, and I was, you know, for my master's project, I did a lot of HIV work, mainly in sort of communities of color, and I was actually asked in my Master's project because they knew I had an anthro background, they were having a hard time getting Haitians living in New York into HIV studies, and there was a large concentration of Haitians in New York that had HIV, but they could not get them into care, and they couldn't get them into any research projects, and so they wanted me to kind of go out and figure out why they weren't coming in. And I didn't really know very much about Haiti. I didn't know about Haitian experiences in the US frankly at that time, and…it's embarrassing to say I didn't really know the history of Haitians and HIV really, because…I was very young when all of this happened. And so when I went into these communities and started talking to people there was a real feeling of stigma around what had happened to them, how they had been labeled as disease carriers. And I think what was more profound and meaningful to me was how much we had in common. As someone who fled as a young child, fled a civil war in Sri Lanka, and what it was like to sort of flee violence in Haiti. There was a lot in common that I didn't realize that we had, and so there was a lot of mutual understanding, a lot of kind of going back and forth. And my intent wasn't necessarily to get them into these studies, but to rather sort of inform the [Principal Investigators] and the investigators that I worked with why they felt like these studies were only going to restigmatize them. Right? It was more I felt like my job to say, this is why this is happening. Rather than force people into things that I didn't really feel like it was their choice. Ultimately, I wanted to make sure that they had the care that they needed and that they were getting, that they had the medication and that that had a huge impact on what I was learning, what I was doing, who I wanted to be, I think, and moving into the PhD realm, that's what I really wanted to focus on. I wanted to actually understand sort of this lineage, what was still happening in Haiti, around HIV, and what is what was happening potentially, to people who were also coming here and being faced with the same sort of issues. So the book was around the time where there were these large campaigns around sort of destigmatizing the disease, in terms of how we all had AIDS, everyone had AZT, equal access to HIV medications and HIV care. And so I wanted to also understand how Haitians were dealing with it, mostly in Haiti. That was where my project was supposed to be based, as a result of circumstances that were not under my control. I could not work in Haiti. It was during that time that Aristide was in power and there was a coup, a military coup that many would say that the US was responsible for, and it was not a really safe time for me to be there and to do research there. So I actually pivoted and worked with Haitian communities that I knew really well around the country. And I thought Florida would be the easiest because I could also then sort of think about how people got care in both places and why that was and why that was and why that was important to them. So the book really revolved around a lot of the structural sort of challenges, the stigmatization that was happening, and the unevenness of how researcher resources that were distributed between immigrants in Florida, particularly those who were sort of racialized as black, and those who were not.

Joseph Harris  08:23

So within the discipline of anthropology, obviously, Paul Farmer's work on health and structural violence looms large, working particularly in Haiti. How did treating AIDS connect to that? Did it?

Thurka Sangaramoorthy  08:37

No, I think you know he's he was an inspiration to many of us, right, especially in my cohort, a profound sort of someone who didn't have to settle between disciplines and the way that a lot of people that I know, that I went to school with, that I was trained with, are duly trained in either MD PhDs or MPHs with PhDs in anthropology, so that's sort of like how his work was influential, is that I didn't have to give up one for the other, that I could do both. I was interested in the transmission of disease and the social, epidemiological sort of components. But I was also very much interested in how people thought about themselves in the world and their bodies and their health as well. And so, you know, on a broad level, he was incredibly inspirational. His work was inspirational. I also thought my work was much more focused on the diaspora communities in the US that it fulfilled, perhaps the fact that this wasn't just happening in Haiti, that there was a whole slew of circumstances that were happening right across the water, very much in the vein of how he was arguing about the structural sort of vulnerabilities that people went through. My argument was: I think what I added was not just the diaspora community working with the diaspora community, but also thinking about how do health disparities work? In and of itself, it was very generative of keeping disparities alive, in some ways sort of the government notion of health disparities is something that would never go away, that it kind of like just added onto itself. And there were no interventions in the way that I saw them, especially in HIV for black immigrants, that you know the framework is there in terms of people are differentially sort of experiencing this, yet the resources never match that. And so that's the paradox that I was trying to talk about, that is that it's not just sort of global powers as much as the state itself that actually keeps reproducing the very same things that it seeks to remediate.

Joseph Harris  10:45

So some well known books in anthropology on HIV/AIDS have taken up the issue in faraway contexts, and particularly in Africa, I think of people's work like Adia Benton’s HIV Exceptionalism, which takes Sierra Leone as its focus, Nora Kenworthy’s Mistreated on Lesotho, Ippolytos Kalofonos’ All I Eat is Medicine, which examines Mozambique. Why did you feel the immigrant experience in the US is particularly important for you to take up? You've spoken to this already somewhat. But is there anything you want to add? 

Thurka Sangaramoorthy  11:19

So it's interesting, because, again, my first choice wasn't to study Haitian immigrants in the US. That was my very much, my public health project and my master's degree. Again, I came to it not of my own sort of initiative. It just sort of happened. It was the choice that I had, or I felt like I had, it would have been Haiti. It would have been Haiti, right? Very traditional anthropology, I'm sure, I think I learned a lot looking back on it, right at first, I felt like this was just sort of the thing that I was resigned to do, like it was lesser than to do work in the US interestingly because it was very much that is the convention in anthropology, and a lot of times that is how I was made to feel, like this was easier work. It didn't really matter because it wasn't in a global context, etc. 

Joseph Harris  12:04

That's so interesting, because it's opposite of sociology!.

Thurka Sangaramoorthy  12:08

Exactly. And so these are the things that still remain in our discipline, which is really unfortunate. And you know, I think I learned so much because I was trained in a very global context. So the eyes through which I saw what I was seeing in Florida was very much globalized. I mean, I don't know how you can be in sort of South Florida and not see things as global. But I think it's also important to say all of the things that we study abroad actually happen here. And it's interesting that you bring these books up, because I know all of these people, again, a very similar sort of cohort in generation, and ippy and Adia. And I actually have a paper that we co-wrote together on this notion of positive living and HIV, where we compare we worked in the same time frame, and we compare Sierra Leone, Mozambique, and Little Haiti in Florida through the lens of thinking about positive living and what the local and the global actually mean, right? And how sort of these colonist frameworks actually sort of…move about in various different spaces because Little Haiti isn't the US in some ways. Is it, right? And so what does that even mean? What does that look like in the US, right? How do we talk about these kinds of places that are inherently global but yet very local too? So I think it's…I'm very lucky in a sense that I have colleagues that are willing to do this kind of…thinking that I think is much more graciously, like, productive in ways that I want to think about things instead of just thinking about it. And like, well, you work in the US, and you work really in global sort of settings. You know, that's not I feel like we need to do better than that. So I'm very lucky that I have colleagues that see things this way, and hopefully the discipline is changing as well. 

Joseph Harris  14:11

I love that. So a lot has been written about the Global Fund to Fight HIV, AIDS, TB and Malaria, the President's Emergency Program for AIDS Relief, also called PEPFAR, and other important organizations devoted to AIDS treatment and prevention at the global level, in what ways, if any, did your work connect to those broader institutions working at the global level, and more generally, growing interest in HIV, AIDS and global health by scholars and practitioners. 

Thurka Sangaramoorthy  14:42

In the 1990s they tried to recruit me to work for PEPFAR, and I've always avoided in terms of working for, you know, it's interesting because I've always, because I've always worked in sort of what I would consider domestic, federal, sort of spaces. HIV, not just in my research, but I actually worked at CDC as a postdoc for several years working in HIV work. And so the domestic programs are structured so differently, and their resources, you know, are not they operate under the same sort of politics in terms of certain kinds of administrative ideologies that kind of govern both and perhaps the funding structures lean in particular ways, depending on the administration. Perhaps that I also think that, you know, I don't really engage with PEPFAR in a lot of my work, but I also think it's really interesting to see how these different funding structures actually have very similar effects, and how they impact and create sort of disparities among populations in general, and how certain groups actually buy because the resources are so limited, how they position themselves in accordance to kind of getting certain kinds of resources right. So I think that kind of relationships are very similar, even though they operate in entirely like PEPFAR is very sort of global. It does not operate on that on a domestic level, but we have very similar funding structures that I think, you know, we don't often think about and actually interrogate in the same way that we've interrogated PEPFAR. So I do think that that would be those, you know, different financing schemes for different diseases here would be really fascinating as a form of study. 

Joseph Harris  16:40

Going back to Treating AIDS and thinking about that in relation to those institutions, what impact - if any - did that book have on the policy and practitioner worlds? Can you say a little bit about its reception? 

Thurka Sangaramoorthy  16:51

Treating AIDS was my first book. It's my dissertation to book conversion. I'm not sure that I had any sort of inclination that I would have any sort of practical applications in the world because I wasn't ever really taught to write my dissertation that way, right? So I'm not sure, as I was writing the book that it was really meant to make sort of theoretical interventions and not necessarily practical ones. I think the one thing that I did want to point out is that it was very, very much about how patients were treated very differently in comparison to others when they had a higher disease burden, that that sort of equivalency didn't actually make sense in the numbers. It didn't make sense in sort of how people framed things. And it was really, it was so obvious and so visible that I couldn't believe that people didn't see it. And perhaps that was the intervention, right? That actually, sort of, not necessarily exposing that, but sort of reiterating just the stark disparities that were happening in Florida to a population that had long been seen as “less than.” In a state or region that was very much an immigrant enclave, they were treated very differently.

Joseph Harris  18:23

The discipline of anthropology has tended to give much more attention to global health issues, as we noted a minute ago, like infectious disease, than other social science disciplines like political science and sociology. Why is that? And it sounds like you do see that changing, or you hope to see it changing. Can you say a bit more about that? 

Thurka Sangaramoorthy  18:43

Well, I think, you know, medical anthropology is one of the biggest subdisciplines of cultural anthropology, right? I think there's an actual sort of…I don't know if we would call it a subdiscipline, because it's a subdiscipline of a subdiscipline, right? In a way it's had some of the largest growth in terms of numbers, in terms of training, in terms of PhD students. And I think that, I think maybe because we sort of, this is kind of going out on the limb, but I feel like this notion of health isn't just sort of biological or, in the sort of framework that many of us think about in terms of when we think about health. That's not just about like medicine or bodies, but rather sort of, it's a much broader definition of health that I think fits into the kind of anthropological framework of sort of an absence of equality, in terms of social equality, political equality, or economic and, you know, equality, that all of these things are sort of warming together into a sort of condition, this thing called health and wellbeing, right? So I think that there's a that a lot that anthropology frames is that it's broader than perhaps what some of the other disciplines do. And I also think that we work on social inequality in general, globally, sort of framed. And health is one of the biggest things where this is actually found. And I think that's a natural draw as well. I think, you know, someone like me, when I teach an intro to medical anthropology, I start with Evans Pritchard and witchcraft, right? So there's already things in our discipline, whether that's visible lineage or not, that already speak to sort of religion and witchcraft and other taboos, right? All of these things that kind of explain why? Me, why? Now you know all of these kinds of questions that really relate to how we think about health in general.

Joseph Harris  20:57

How has work from other disciplines informed your own work? And I should say for our listeners, just before the podcast started, we were talking about how your latest book won an award from the ASA, which is the Sociological Association. So could you say a bit about that?

Thurka Sangaramoorthy  21:15

So I'm someone who came into anthropology because I was interested in other disciplines, like anthropology, was really the discipline that made me feel, even as an undergrad, that I could kind of combine all of my interests into one thing, and it would be perfectly fine. So I think many of us perhaps have that same kind of leaning. And you know, I'm duly trained in epidemiology and in anthropology, I would say, you know, it's not as easy to kind of combine that work in the academy now, at this stage, which in some ways is really unfortunate, we are still very much somewhat separated. Our journals are separated. The tenure process is very different. But you know, in this book, in particular, I do draw on a lot of public and global health work. I draw, you know, a lot of the work in the US on rural issues is really done in sociology. I think anthropologists have kind of cornered the rural market and global spaces, and in the US, it's really been sociologists. I took a lot of work from sort of labor people who work on labor, Marxist black feminists. So there's a lot of people whose work or whose sort of shoulders that I stand on in thinking about the space. And so I also think that that's really important to be constantly aware of how other disciplines and other people writing in various different disciplines actually influence the work. I think that's always…I don't know how to think any other way personally.

Joseph Harris  22:56

What do you see as some of the most pressing issues in global health today, and are there any emerging scholars or activists working on those issues whose work you particularly admire or follow?

Thurka Sangaramoorthy  23:11

What I would say is, as someone who spent the last four years living in Ethiopia on and off, but for the vast majority of time working there and then having the profound privilege to actually work on the Sudan response and being able to travel to South Sudan. I couldn't get to Sudan obviously, but to South Sudan frequently, I think, for me, actually living in a place and not just studying it, like actually living there, being present, seeing sort of humanitarian crises fold in both the country that I was living in and the country that I was working in. I think there's a profound sort of way that humanitarian crises are no longer just humanitarian crises, their climate and health crises as well. And you know, it's going to take me a while to kind of right through this, because it was such a visceral sort of experience for the last two years, I would like to see more people actually talk about that nexus between humanitarianism, humanitarian crisis, rights, displacement, violence, health and climate together. 

I think there is a growing body of work that is doing work on climate and violence and health and violence, but I honestly think that these things are not…They're inseparable. They're actually unfolding, and they're already in progressive sort of stages like this isn't something to come where I lived and where I worked. It's already there in full-scale force. And so I don't know if our research is quite there yet, and I think it needs to be because the situation is just getting worse. I haven't read too much on this, like I have not had the mental bandwidth or the space to really read so much on it, but there's a lot of people on the ground who are doing critical work, whether it's in nonprofit spaces or activist spaces, that actually are incredibly knowledgeable. They may be not writing about it in particular kind of visible forms that we tend to think of as research, that I think there is a lot out there that we are not necessarily sort of thinking about, and maybe we're not doing it because there are very few agencies that are willing to sort of fund this kind of work that is truly sort of bringing lots of different things to kind of together to bear. But that's what is actually happening in spaces. You know, East Africa is ground zero for some of this stuff, and so I would just encourage people to really think about how we can kind of bring these different elements to actually speak to each other.

Joseph Harris  25:53

In 2020 you published your second book, Rapid Ethnographic Assessments. How does that book fit into your broader research agenda and general interest in global health? And how has that been used and received?

Thurka Sangaramoorthy  26:08

So I wrote that book based on the work that I did at CDC, so it wasn't really what I would consider to be academic work. It was research, but it was not necessarily academic, and I wrote it. My coauthor is my former supervisor at CDC, who's a PhD holding anthropologist. And we wrote that book really for non-academics. It fits in with my vision of someone who really was never taught methods at all. I was told to figure it out in the field and then actually went to a space where I have to constantly be thinking about methods and to explain my methods and to justify my methods. So I thought about methods quite a bit.

Joseph Harris  26:54

That place being the CDC.

Thurka Sangaramoorthy  27:00

Anyway, that work came out of the fact that a lot of the work that the CDC is well known for. What we know the CDC for is disease outbreak investigations. And I worked in infectious diseases and in infectious diseases, diseases out disease outbreaks, oftentimes around things like TB or STDs, like syphilis that I worked on, these are no longer these discrete outbreaks the way we traditionally think about them, epidemiologically, right? They last for a long time. They last for years and years. And so we would argue that it wasn't just okay just to look at sort of a particular outbreak, and I mean, even if we did, it wasn't just about epidemiological records. We really needed to understand some of the root causes of what was was keeping these outbreaks sort of constant over time? And that required something that was ethnographic or social sciencey, right? But it had to be very quick, because people needed specific kinds of tools to be able to produce findings or recommendations that they need, that they could react to very quickly. So when you essentially have a week to do this, you need to kind of modify the method to not to make it “ethnography lite,” as some people would say, but to really think about how anthropology could actually make a difference in a very specific context in a very specific way, and to provide people with practical recommendations that someone can do something with, and rapid ethnographic assessments is essentially a team-based method. If you're doing this alone, you're not doing rapid ethnographic assessment. And that's also very different from how we are trained to do anthropology as a lone anthropologist. And so this is a method that isn't something that I invented or that we invented. It's been existing for a long time, since post-World War Two. In development, where either something we didn't know very much about something, or something happened very quickly and we needed to react to it, or we needed to evaluate if something was going well or not. So this method has been called different things. I think what we ended up doing was we talked about how we used it at CDC, why it was useful, why it's actually necessary to think about sort of not the rapid assessment, but the rapid ethnographic portion of that assessment, and why that's important to sort of incorporate, why we needed to kind of take it more seriously and why it can have really useful effects in the world. But it also kind of aligns with my vision of moving research out of the academy altogether, that this is something that communities can do themselves, that people can train others in. It's really a practical step-by-step book, and I think that it has been incredibly useful. I think in most of the commentaries what I've been actually surprised at is how many people are actually teaching it in the university setting. That was probably my biggest surprise, that people are using it in anthropology classes, which is really interesting.

Joseph Harris  30:23

Why is that?

Thurka Sangaramoorthy  30:24

Why is it interesting to me? Because I wasn't writing it for anthropologists to use, and I was also told that anthropologists don't write methods books.

Joseph Harris  30:39

This leads to so many questions. But the one I want to seize on is this point you make about the need for research to really start or begin outside more the academy. Can you say more about that? Why? Um, I mean, we're known for our expertise and methods. 

Thurka Sangaramoorthy  30:58

Yes, I think part of what we talk about in rapid ethnographic assessments is that research is inherently a hierarchical process. There are researchers who have a theoretical framing, they have the methods, and then they go into communities and they just do the work. Perhaps they report back on it, perhaps it has some sort of effect in the community, right? It's to really disrupt that kind of narrative and that kind of hierarchy. It's about saying: how do we work with communities to actually figure out what is important to them? Are there things that they want to know more about? And the community isn't just sort of a vulnerable community. It can be a community. This is where we, I think, have failed. Culture exists anywhere. There's a culture in a hospital amongst emergency group physicians, for instance, they have a culture. So communities exist everywhere. And so sometimes, it's an institution with a particular program, perhaps that needs an answer and doesn't really know what to do, or they don't have the staff or the capacity to actually sort of undertake something. But that's what I'm saying. It's that it's not sort of a mystified thing. Research shouldn't be mystified, right? It shouldn't be only at the hands of the privileged few. Everyone should have access to it, and qualitative research is incredibly powerful. It can have really powerful effects in the world, and it should be available and accessible to anyone. So that's sort of where I feel like I'm coming from.

Joseph Harris  32:31

Share with us a little bit about your latest book, Landscapes of Care: Immigration and Health in Rural America. How did that come into being? What motivated you to write that?

Thurka Sangaramoorthy  32:41

So when I was working at CDC, I did a lot of outbreak investigations in the rural South, mostly in the Southeast, and I was really stunned to see a lot of the concentration of immigrant communities in those settings. I'm largely from the Northeast, in major cities, and I had no idea that places like the Carolinas or Georgia had a lot of immigrants. I was also seeing disease outbreaks happen in places that just didn't know what was happening, like they were small towns, small cities, places that weren't really traditionally, how we think about large outbreaks, right? And it wasn't just the sheer numbers, it was the rate, right? The relative rates. And I was always really curious. And when I moved to Maryland to start an academic position at the University of Maryland, I wanted to work on immigration, but I was insistent. People were like, well, there's DC, there's Baltimore. Those are the places in Maryland, and again, it's a land grant institution. There's a lot of resources for studying things that are happening in the state. And so I thought this would be really interesting to do. I was always sort of told that there was a lot of work to be done in DC and Baltimore, but I was really interested in working in rural Maryland. And most of Maryland is actually really rural, and the eastern shore is just this fascinating space. It was separated by the bridge until the 50s, and it's very, very rural. And I wanted to work there…I was an expert in immigration. I'd worked in health, and I had connections through CDC and other University of Maryland contacts. And I went to go talk to people there, and they essentially told me that I didn't really, I wouldn't understand immigration until I understood rural health and what it was like to think about healthcare in rural spaces. And I had no idea what that meant, and I continued to work there, and it when I would ask that immigration people will start talking about rural health. Rural Health became sort of a very sort of central feature, something that I could not ignore. It was forcing place back into sort of the equation, so to speak. And I think I was based to actually confront the fact that most of my training, and I think most of all of our training, is grounded in this sort of urban context in ways that we don't even think about. But a lot of what I saw there, I don't know if I would say that I've seen in other places, the under resourced thing, I think, exists in many places, but some of the things that people were doing in the absence of was really sort of particular, I think, to the landscape itself and the environment itself, like exchanging crabs for healthcare, right, or watermelons, sort of seasonality and labor and just the land. And so I think that these were it was trying to so the book is really about immigration, but it's about how immigration is actually grounded, how we need to also ground immigration certain spaces, and why that's important, and why sort of the neglect and rural health care actually has a huge influence on how immigrants sort of are cared for and receive care and navigate care, and how rural spaces are incredible sites of globalization and innovation, in a way that I think, that we don't think about, and we're sort of our political and social imaginaries about what rural spaces are supposed to be as this backward, deficient space, you know, we call them flyover country, right? And what that sort of does. And I don't know why more people don't write about rural health because what's happening there is essentially happening in a lot of different places, not just in the US, but globally. Right in a sense that's they're struggling with migration and global governance in many ways, and the and the under resourcing of certain places over others. And so I really wanted to write a book that paid equal attention to both.

Joseph Harris  37:24

You're listening to the Global Health Politics Podcast today. We're talking with Thurka Sangaramoorthy. We'll be right back.

Joseph Harris  37:39

So for the past two years, you've served as Refugee Coordinator for the State Department's response in Sudan and South Sudan, working at the US Embassy in Addis Ababa. How did that opportunity come about? What was that experience like? Did you feel like you were able to make an impact?

Thurka Sangaramoorthy  37:56

So I first went to Ethiopia in 2019 as part of an academic, a multi academic team that wanted to work on sort of this confluence, or this nexus between energy water, energy food water and health and Ethiopia was undergoing, what some would say at that time was sort of quite revolutionary. It was on an upswing. In 2019, the then Prime Minister had just won the Nobel Peace Prize. The sentiment was that it was one of the largest growing economies on the continent. And in terms of higher education, there was a particular focus on renewable energy resources, commercializing agriculture that was climate smart, and really thinking about sort of health in a very different sort of way. And unfortunately, within a year, that all changed, and I went back in 2020 for other reasons, due to sort of my family moving there and spent a lot of time, you know, unfortunately being restricted to the capital because the civil war was going on between Tigray and the government, and I really couldn't do the work that I was set to do unfortunately because much of it was in the north and so I actually spent a lot of time in Ethiopia, teaching at Addis Ababa University, teaching methods and helping students learn more about medical anthropology. And I knew people at the embassy, and they knew me. They knew that I was an academic, what my specialties were, particularly in health and in the area of global health in particular, and in migration. And the State Department has a Bureau of Refugees. I'm sorry, Population, Refugees and Migration. PRM, and a lot of the refugee coordination for the Horn of Africa is from Addis Ababa at the US Embassy. And it oversees five countries, Djibouti, Ethiopia, Eritrea, and Sudan and South Sudan, which has one of the highest concentration of refugees in the world, and it's one of the largest sort of portfolios in terms of financing and aid, humanitarian aid for refugees. In particular, they had a need for more people to work in that region, they didn't have a full staff staffing there, so they asked me to interview and I at that time, I was changing institutions back in the States, I went to American University. And they said, well, the clearance process, you got the job, but the clearance process will take a very long time, over a year or so. And I said, “Great, because I have a job. I need to go back.” I came back to American and about six weeks later, I was in a new job. This was a new position. Six weeks later, the State Department called, or the embassy called and said, “Your clearance went through lightning fast, and when can you come?” And I said, “Well, we’re not coming now. I just started this job in the middle of the semester. I can't just leave.” So they asked if I would come at the end of the semester, and so my department was extremely supportive. I went. I was actually doing two full time jobs at the same time because of the time difference. For me as someone who would consider herself a former refugee, what I do as an academic and who I am are not two different things. I do exactly the work that is meaningful to me and that has like actual significance in my own life. So this was a way that I felt like one I could learn a lot about a region that I didn't really know very much about, which was Sudan and South Sudan, which what I was given responsibility for, what I was not expecting was the Sudan crisis to start four months into my job that unfolded really rapidly, and that's essentially what I worked on for the last two years. 

It was incredibly intense. It's not easy to work for the US government, but I think for me, you know, I had a history of working for government that wasn't sort of it was just actually working in the middle of a crisis, and in the middle of a crisis that I you know, it still has not ended. So the intensity and the severity of what was actually happening to those populations, how one was making decisions on that could actually have an impact on people in spaces that you couldn't even actually visit these spaces and had to make sort of drastic decisions was really It weighs heavily on you actually being able to visit refugee sites where people have fled and actually having access to people and to be able to sit down and talk to people, the level of access is incredibly profound, and I'm very humbled and thankful that I had the opportunity to do it. And I met with a lot of people, you know, international agencies, individuals, advocates, foreign policy people that were all working very hard to kind of figure out solutions to this in terms of my own sort of impact. I think again, I was in this really strange position. I'm not a Foreign Service Officer. I'm not a permanent sort of person there. This was a very sort of a limited time appointment, and I was known as someone who had expertise, right? I'm not a generalist. This is the work that I already do. So I felt like I, you know, in some ways, very much an outsider, but also someone who had expertise that people kind of depended on, in terms of, you know, getting what I thought, you know, I think probably the biggest impact that I had, and I'm only saying this because they gave me two awards, was that I think I was really trying to kind of think through this. 

I never sort of hid the fact that I was an anthropologist. That's how I was thinking about it, that I was also a global health expert, and wanted to bring to the front from forefront, the health impacts of this level of displacement, the way that people moved, the concentrations in which they were moving, the kinds of routes that they were taking, right the fact that Sudan has largely. Because of this legacy of violence has also been concentrated in urban areas, largely Khartoum, right? That's where most people were fleeing from at the very beginning, and that route that they were taking, fleeing South, that's essentially a health disaster corridor. And so to help people sort of think through this and these particular ways about where we should be, sort of thinking about what should we should be anticipating, that if it wasn't sort of violence, direct violence, that was going to kill them, it was all of the things that were going to happen to them on that route, in terms of health, in terms of, sort of then the rainy season, what that would do, et cetera. And just to think about health and climate, not as non-essential, sort of humanitarian disasters like that then happen later, but that they're all happening at the same time. And just to get people to sort of think about even with limited resources and funding, maybe to anticipate these things and to put resources there too. So I think, realistically, that would have been the thing that I think I was most proud of. 

Joseph Harris  46:09

It's such an unusual role for an anthropologist. We don't usually see this. We talked about this before the podcast. Would you encourage other anthropologists and social scientists or scholars of global health to have practitioner policy making experiences like this? 

Thurka Sangaramoorthy  46:24

I think it's incredibly valuable. It's not just valuable. I mean, if I'm not learning I don't know why I'm in the academy, like that's what brought me to the academy in the first place. So if I'm not constantly being challenged and learning something I don't know, I think I would be really stuck. I would really encourage people to pursue these kinds of works. I think the government was really, really open to working with the academy. I'm not sure the academy was really open to having me there, right? 

I often feel like I had to make a choice, and that's really unfortunate because I think we can do so much for our students. There were times where I was in really sort of very restrictive spaces, calling in to teach my class and telling students like not necessarily revealing what I was doing per se, but just to say, this is where I am, this is what I'm working on. And I think for students, those are really important things. We're training students to be sort of critical thinkers right outside of the academy, I think, for much of this, and to like be people in the world who are sort of having an impact. And so I think it actually matters. And I wish there were more opportunities. I wish it was easier to do this kind of work without having to make a choice that many of us often feel like we have to make, that we can't do both. 

Joseph Harris  47:52

I'm going to ask you to put your scholar hat back on and talk to us a little bit about the research process. What would you say are the most meaningful parts of the research process to you? And do you feel like there are any parts of the research process that just don't get enough attention, or that we don't talk about enough?

Thurka Sangaramoorthy  48:12

I think at heart, I'm, you know, I really take methods to heart. I feel like there's a dearth of doing. I think we teach people to think. And maybe some people would argue with me on that, but I think we do a lot of theorizing. I think we teach theory well in the academy. At least in my discipline, there's a lot of focus on theory. I think methods…oftentimes how we teach methods is like reading about people doing methods. And I also think that we teach them separately, divorcing theory for method. And I have a really hard time with that and really getting people to see sort of how those two things are really cannot be separated. One informs the other, and one isn't necessarily sort of an afterthought. 

Oftentimes we think of method as an afterthought, you know, and I think that's really important in a lot of my public health work or global health work, especially the interdisciplinary sort of projects and teams that I'm on with those who are not social scientists at all. I feel like this is also another thing that that we run up against, right? 

That somehow the theory and the method or the framing or the conceptualization of the problem, and then their methods are sort of are thrown in right without sort of a real, sort of alignment about why we're picking and choosing certain things and how they're aligned. And I think we need to be better about that. And I think we need to be better, both as researchers, but as also as teachers of training other people how to really think through this. And there are projects that are that really are not aligned in terms of their theoretical framework or their conceptualization or modeling, right, and then the methods that kind of go along with it. 

So I think that that's something to me, is really, really important to think about. And sometimes it's okay not to do the method that you started off thinking that you were going to do and to actually sort of be in the field for a little bit and rethink those things, right? Is this really useful? Is this really going to give me…Is this really working, right? Is this giving me the information that I really need? Maybe something has changed. So I think, to me, that's the most important thing about research. I also think one other thing that I would emphasize about research is that I think as researchers, we need to have so much more humility in terms of the fact that actually, except that we don't know very much, and then we can't come into it with a big…I know it's putting the cart before the horse, or whatever it is, right where we write a grant, we have to have the framing. We have to have everything sort of figured out. We have to have something already written, and we then just sort of take that and carry it into the field, rather than having the field actually inform us and perhaps be changed by the field altogether, right? And, and I think that's okay too. 

Joseph Harris  51:17

Who are some of your biggest influences in terms of writing and research. And are there any practices or habits that you found indispensable in helping you in the process of conducting research?

Thurka Sangaramoorthy  51:28

I think my biggest, I mean, I do enjoy reading colleagues books and others who you know from various different disciplines. And I think there are, you know, giants that we all read in terms of how they write and how beautiful their writing is, but honestly, the people that teach me the most are the people that I actually work with, the communities that I work with. I think those are challenging sort of sets of considerations that one has to navigate all the time. I think they teach me more about myself than sitting in a classroom or, like, thinking along with others. And I think that's where the growth really happens, the intellectual growth and the sort of the personal growth actually happens. And I think those are the kinds of decisions that I've made along the way, like, in terms of moving methods out of the academy, like, that's not something that I sort of came to. It's just over time, working in communities and training people in the communities…being in those kinds of spaces is what I feel like, where a lot of my vision and thinking around research really comes from is the people that I work with.

Joseph Harris  52:49

Last question: if you could give first year PhD students doing work on global health one piece of advice, what would it be?

Thurka Sangaramoorthy  52:59

I think this makes me sound really old. How I was trained in global health was very much in a very social science way. I mean, I had traditional epidemiological training, right? But I think the most sort of profound things that I read were from the social sciences. You know, I did my MPH or not my PhD, but I did my work in global health during a time where we didn't have a lot of PhDs in public health or global health. We had people with specific disciplinary sort of training. I was taught by historians and psychologists and environmental scientists, political scientists, sociologists, anthropologists, and I think, you know, I think it's really important to sort of also understand how different disciplines actually approach global health. I think to me, that was really what was so profoundly interesting about my training.

Joseph Harris  54:10

We've been speaking today with Dr. Thurka Sangaramoorthy. She is Professor of Anthropology at American University, and her latest book is Landscapes of Care: Immigration and Health in Rural America. Thanks so much for joining the Global Health Politics Podcast. Thank you so much.

Thurka Sangaramoorthy  54:27

This was such a great set of questions, and I really thank you for getting me to think about them. 

Joseph Harris  54:37

The pleasure was all mine. 

This podcast was edited by Margot Sevenants. Thanks for listening.

Margot Sevenants assisted in the production of this transcript.