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Untitled Travel Log, 2012. By Miriam Syowia Kyambi and James Muriuki.

1 4 N o v e m b e r 2 0 1 3 – 9 F e b r u a r y 2 0 1 4

First published in 2013 by Wellcome Collection, part of the Wellcome Trust, 215 Euston Road, London NW1 2BE.

wellcomecollection.org

Copyright © the Wellcome Trust 2013

!e moral right of the authors has been asserted.

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the publisher.

Commissioning Editor: Kirty Topiwala Managing Designer: Marianne Dear Research and commissioning: Danielle Olsen Developmental Editor: Lucy Shanahan Assistant Editor: Tom Freeman Production Co-ordinator: Petra Essing

Printed and bound in Great Britain by Tradewinds, London

Any omissions and errors of attribution are unintentional and will, if noti"ed in writing to the editor, care of the Wellcome Trust, be corrected in future printings.

All the artworks shown here were exhibited at the Wellcome Collection exhibition Foreign Bodies, Common Ground (14 November 2013–9 February 2014), curated by Danielle Olsen and Lucy Shanahan. All artworks are reproduced by the artists’ kind permission.

wellcomecollection.org/foreignbodies

F O R E W O R D

Foreign Bodies, Common Ground by Danielle Olsen 6

I N T R O D U C T I O N

Engaging Hearts and Minds by Peter Piot 8

!e Moral Life of Science and Art by Michael Parker 12

A R T I S T S A N D T H E I R R E S I D E N C I E S

Elson Kambalu, Malawi 14

Lêna Bùi, Vietnam 18

Miriam Syowia Kyambi and James Muriuki, Kenya 24

B-Floor !eatre, !ailand 28

Zwelethu Mthethwa and the Mtubatuba Workshop, South Africa 32

Katie Paterson, United Kingdom 36

Acknowledgements and further reading 42

C O N T E N T S

6 Foreword 7

!e pages that follow capture some of the extraordinary artwork created from the Art in Global Health residencies. Alongside, researchers respond to this, considering the focus and challenges of their own work.

Today, art and science are often placed at opposite ends of the spectrum of human understanding. !is hasn’t always been the case and nor need it be now. !ey complement each other in important and well-documented ways. Both spheres of enquiry provide

tools and approaches for exploring – for building on what we know, for shedding light on what we don’t. And it is here – at the borders of knowing and not knowing – that disciplines of any sort (not just art and science) can work together to yield such rich rewards.

Specialisation and expertise, the carving of niches and the entrenchment of disciplines, are valuable and important but they can also lead to exclusionary hierarchies and impenetrable languages. We can avoid this, and broaden our thinking, by bringing people together with widely varying viewpoints, encouraging thinking ‘outside of the box’ and an appreciation of di#erence. Placing artists within scienti"c research institutions is one small way of bridging discourses and practices, of creating opportunities to challenge ideas and think anew, of encouraging moments for self-re$ection.

Enabling meaningful encounters between di#erent ways of seeing and understanding is particularly important for global health research. Researchers might broadly agree

F O R E I G N B O D I E S , C O M M O N G R O U N D

D A N I E L L E O L S E N

What happens when you invite artists to explore the work of different scientific research centres around the world? In 2012, with its Art in Global Health project, Wellcome Collection did just that – six artist residencies in Kenya, Malawi, South Africa, Thailand, the UK and Vietnam. It was an innovative and timely enterprise – a wonderfully collaborative investigation of local forms of knowledge production, both scientific and cultural. This guide, and the exhibition it accompanies – Foreign Bodies, Common Ground – bring some of the outcomes together.

Left: Elson Kambalu with Community Advocacy Group members in Chikwawa, Malawi.

Right: B-Floor Theatre visiting a laboratory in Bangkok.

on their tools and objectives but the social relevance of their work is shaped by its cultural context, an altogether less predictable realm. And this is the world of the artist. !e artist’s interests lie precisely in the personal, the philosophical, the cultural and the political.

During their encounters in the realms of medical science, the artists were outsiders, or ‘foreigners’, bringing a di#erent set of aims and objectives to those of the researchers they met. Similarly, the majority of medical researchers are often ‘foreigners’ in relation to the communities that they work with, where local perceptions of their methods and protocols can vary greatly. Collectively, these artistic investigations re$ect on cross-cultural exchange and encounter whilst also reminding us of our common ground and humanity.

Such observations are particularly apposite as we witness a growth in collaborative health research and the increasing importance of data as a resource. !e artists prompt us to consider where this information

comes from, how it is used and what motivates or frustrates researchers and study participants. How do diseases spread? How do ideas spread? Where do datasets and mindsets meet – and what role does trust play in all of this? Artists are perfectly placed to elucidate some of the frictions, negotiations and ambiguities that shape this corner of the world.

!e guide that you hold in your hands is one outcome of six very di#erent journeys. Common to all of them are incurable curiosity, thoughtful enquiries, talented eyes and a generous and collaborative exchange of ideas. It provides unexpected insights into scienti"c processes and the intricate web of relationships upon which those processes depend. I hope it will also inspire and delight.

Danielle Olsen is an independent curator.

8 Introduction 9

In recent decades, thanks to medical research, millions of lives have been saved around the world, but millions more still needlessly su#er and die. We are not only dealing with infectious diseases such as AIDS, malaria and tuberculosis but also with non-communicable conditions such as malnutrition, complications of childbirth and, increasingly, hypertension, diabetes and cardiovascular diseases. We are also confronted by the emerging threats of new zoonoses – infections which spread from animals to humans.

In such a world, it is strange to recall that as a medical student in the early 1970s, I was advised against specialising in infectious diseases because, it was thought back then, the major problems had been solved. By the 1980s, the global AIDS epidemic forced us to rethink and confront the complexities of health and health politics in a globalising world.

While we were quick to understand the workings of the HIV retrovirus and develop life-saving drugs, it required a massive international e#ort to slow the spread of the virus and make treatment available to those who needed

it most. Vital to this was understanding, engaging with and changing people’s beliefs and behaviour. Today, we still haven’t developed a vaccine, and AIDS is endemic across much of the world. !is shows both the enormous potential and the limitations of science to grapple with global health problems.

!e health of individuals and the health of populations are interdependent, and if we are to improve human health we need to explore what works both at a micro level and at a societal level. We need to keep researching, building capacity and developing skills. We also, crucially, need to work on understanding the cultural context of such work. International collaborations like those supported by the Wellcome Trust are doing important and in$uential work in this area.

As scientists and clinicians, we are aware of what we know, and what we need to know, to make a di#erence. But we have much to learn when it comes to engaging with policy makers and wider publics and when it comes to communicating the uncertainties, risks and bene"ts of our work.

Rational argument is not always enough. We need to engage hearts as well as minds, and this is where art can be so powerful. Art can help us re$ect and explore both the details and the universality of our experiences. By exploring the common ground among the foreign bodies, this exhibition brings some vital research projects to life in engaging and inclusive ways. I hope it will also remind audiences of our shared goal of improving health worldwide.

Peter Piot is Director of the London School of Hygiene & Tropical Medicine and Professor of Global Health. He was formerly Under Secretary General of the UN and founding Executive Director of UNAIDS.

P E T E R P I O T

Infectious diseases have had a hold on human beings since time immemorial. We are in a dance of life and death with our pathogens and are shaped by them in profound ways – evolutionary, immunological and cultural.

E N G A G I N G H E A R T S A N D M I N D S

10 Foreword 11

Detail of Conjure Skies, 2012. From a series

By Miriam Syowia Kyambi and James Muriuki.

“We talked of gloves being like a border, like containment, maybe like a border between two elements; one maybe the researcher or the doctor and the other the patient or whoever the subject, protecting the two sides – yet sometimes it’s easy to think of them as protecting one side… And the way we took the pictures, I think of them as existing in a sort of spiritual, non-physical way… it’s a sort of symbol of energy present in an environment.” James Muriuki

12 Introduction 13

!is, however, has improved somewhat in recent years – in no small part thanks to collaborative research networks involving partners in high- and low-income countries. One of the most important such examples is the work carried out by the Wellcome Trust Major Overseas Programmes (MOPs) in Vietnam, Malawi, !ailand–Laos, South Africa and Kenya.

!e work displayed in Foreign Bodies, Common Ground responds to and illustrates the ways in which biomedical science is increasingly a collaborative endeavour, linking multiple locations in both low- and high-income settings. Taking the MOPs – and the Wellcome Trust Sanger Institute in the UK – as their starting-points, these artists give a powerful and provocative reminder that science is a distributed activity. At the same time, however, they engage with the ‘place’ of science, powerfully illuminating the ways in which science is also profoundly and intensely local. Both science and art are here enacted locally and globally, and in the shifting relations between these levels.

In my own work, with the Global Health Bioethics Network – which also spans the MOPs – I am concerned with understanding the moral life of science and the role that identifying and addressing practical ethical problems plays in biomedical science. It is clear that

the growth in collaborative global health research brings with it complex ethical issues arising out of the interplay between globalised research and the ways in which such research is manifested locally. What are the responsibilities of researchers to the communities in which research is carried out? How can scientists develop e#ective solutions to practical ethical problems in the context of con$icting, ambiguous and sometimes contradictory guidance and regulation? What are the obligations of researchers in collaborations between organisations with di#erent and sometimes competing interests, concerns and priorities?

!ese concerns, of course, resound in the work of the artists collected here.

Michael Parker is Professor of Bioethics and Director of the Ethox Centre, University of Oxford. !e Global Health Bioethics Network works across the Wellcome Trust’s MOPs, aiming to promote and support ethical re$ection, to build their capacity to identify and address ethical issues in their research, and to research the ethical aspects of collaborative global health research as encountered in their day-to-day work.

M I C H A E L P A R K E R

Despite increasing wealth worldwide, there are still enormous and troubling global inequalities in mortality, quality of life and disease. Moreover, although the burden of disease is disproportionately large in low-income countries, only a very small proportion of medical research has historically focused on the problems that primarily affect these countries.

T H E M O R A L L I F E O F S C I E N C E A N D A R T

14 Foreword 15

Detail from a painting created by children from Mawila School, Chikwawa, 2012. The children were invited to portray their experiences and understanding of health research. Blockboard,

pens and pastels.

Elson Kambalu is a self-taught artist based in Lilongwe, Malawi. He works in di#erent media ranging from paintings and photography to sculptures and installations and is increasingly drawn to conceptual and participatory work. He is interested in listening to and sharing people’s stories and creating works that stimulate debate. Living in a country with few support structures and educational opportunities, Elson is also keen to support others with their artistic endeavours. He owns two art galleries, runs an arts and cultural magazine and, in January 2012, opened Blantyre Art Club to support vulnerable groups in the study of visual and performing arts. Elson’s work has been exhibited in Germany, Norway, South Africa and the USA.

While in residence, Elson explored both traditional and contemporary approaches to medicine and research. He interacted with a huge variety of people in urban and rural settings – from clinicians and traditional herbalists to study participants and tribal chiefs, from community workers and pharmacologists to health economists and musicians.

Fascinated by the cultural complexities between research teams and the communities they serve, Elson invited people to create work inspired by their understandings and experiences of health research. !ese participatory projects allowed people to express and discuss their views regarding research. He also made his own work re$ecting on ‘Kafukufuku’, the Chichewa word for ‘research’.

M A L A W I E L S O N K A M B A L U

“ Many medical words are almost untranslatable. How does one express ‘DNA’ or ‘sequencing’ or ‘genomics’ in Chichewa dialect to an illiterate woman?”

E L S O N K A M B A L U

Research centreMalawi–Liverpool–Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine

Established1995

Key research areasMalaria, TB, HIV/AIDS, severe bacterial and viral infections, vaccines, non-communicable disease

Employees350

Major research labs and field sitesQueen Elizabeth Central Hospital, Blantyre; Chikwawa; Zomba; Thyolo

16 Elson Kambalu, Malawi 17

Kafukufuku Man and Kafukufuku Woman, 2012. Plywood boards, reeds, soil mixed in glue. By Elson Kambalu.

Elson Kambalu meeting with a woman in Chikwawa who uses different soils to decorate the walls of her home – a dying tradition in this area now that mud houses are being replaced by brick dwellings.

One of the outcomes of Elson’s residency was a series of workshops in which 20 women (some

walls) were invited to create soil-based paintings inspired by their experiences of seeking health and their understandings of the work of the research centre. These were displayed together at the Kafukufuku Arts Festival, 2012.

One area that remains a real concern in these rural villages is our interest in blood. “So the blood suckers are coming?” “How can we be sure they do not pool the blood in a big tank and sell it for witchcraft?” In a country where the media regularly report witchcraft stories and most rural villagers have never even seen a picture of a research laboratory, this should come as no surprise. Photos, videos, real-life demonstrations,

or a trip to our laboratory in Blantyre to show the carefully labelled samples stored in freezers are more reassuring than words. And, although shaped by the local media, concerns about the use of personal data in science are global. Just think of the public debates about how our medical samples or data might be used and how our privacy is under threat by technological and medical developments.

Another area of confusion is our e#ort to follow internationally agreed ‘best practices’. For example, explaining that it is not ethical for us to pay study participants because that could amount to coercion into research is globally agreed, a genuine concern and we adhere to it, but if you have the equivalent of 50 pence in your house to feed your kids over the next week, and you

sit opposite a well-dressed nurse and have seen her arrive in a shiny four-wheel drive vehicle, both the invitation to join a research project for the greater good and that explanation may sound, well, like bollocks in Chichewa.

Elson’s participatory projects – working with women in Chikwawa and children from Mawila School – allowed people to express and discuss their views and concerns about research, without fuelling their fears. Using art as a medium, Elson’s work encouraged dialogue between research teams and research participants, helping to highlight agreements as much as di#erences. One day, when visiting women involved in Elson’s art project, to see their progress and drawings of health-related problems, we met a woman whose painting showed a big rhino next to a house and a child. And while I was

wondering how to link the rhino to disease transmission or witchcraft, whether Malawians (like Chinese) may think there are some medicinal properties of rhino horn and whether she may have heard that a few rhinos had recently been reintroduced in the nearby game park, she answered: “We don’t want the exhibition to be boring and as all the other women painted something about health, I thought I’d better do something else. I drew a rhino.” I smiled. !ere is no need to overcomplicate things. She perfectly judged the "ne line between art, entertainment and education, used her artistic freedom and just got on with it.

A pragmatic way to navigate cultural complexities may be to accept that nothing is black and white in life, most problems have a solution, most sensible solutions involve some sort of compromise, and we just have to get on

with it. !e communities and research teams may not fully understand each other, but they do share a strong common interest: to reduce the burden of disease in their families and children. And with that most basic level of mutual trust, communities have generally been strongly supportive of the life-saving research that has been undertaken here for the past 15 years.

Anja Terlouw is a clinical epidemiologist at the Malawi–Liverpool–Wellcome Trust Clinical Research Programme.

Kafukufuku Man and Kafukufuku Woman with its intricate wiring brings to mind the complex interconnectedness between individuals in communities. ‘Kafukufuku’ means ‘research’ in Malawi’s Chichewa language, but opinions clearly differ on what Kafukufuku is and why it is carried out.

E L S O N K A M B A L U A N D C U L T U R A L C O M P L E X I T I E S O F R E S E A R C H

A N J A T E R L O U W

18

Invisible Currents II (of IV), 2012. Indian ink on paper. By Lêna Bùi.

Lêna is an artist based in Ho Chi Minh City. She is curious about how di#erent cultural and sociopolitical backgrounds a#ect our perception. She is also interested in how things connect and interact with each other, how subtle everyday rituals can re$ect beliefs, and broader questions regarding the nature of existence and reality. Lêna’s research-based practice probes into customs, myths and science to examine discrepancies between di#ering realities, and how our behaviours are shaped. She graduated from Wesleyan University, USA, in 2007 and has shown in the USA, Vietnam and Japan. Upcoming shows include group exhibition at the Gunpo Cultural Foundation in South Korea and the Carré d’Art Nîmes in France.

While in residence, Lêna explored zoonosis research – the study of diseases, such as in$uenza, which can pass from animals to humans. She visited rural farming areas where researchers are investigating the human–animal

interface of ‘high-risk cohorts’ - people with high levels of occupational exposure to animals (farmers, animal traders, abattoir and market workers). She also travelled further a"eld, visiting small villages with long histories of economies based on harvesting bird feathers. Her role as an artist enabled her to engage with communities where scientists might otherwise encounter obstructions.

!e outcomes of her residency include mixed media works that respond to the complex and intimate nature of human–animal contact. From the microscopic swarming of bacteria to the swirling of bird feathers, from the $esh and skin of pigs to the presentation of arti"cial meat… each invites us to consider and question our consumption habits and our relationships with other living creatures.

V I E T N A M L Ê N A B Ù I

“ A lot of their work deals with farming and with people’s livelihoods. It can be sensitive. Gathering data itself is difficult because people don’t want to report sickness. There is a stigma about that as it might affect their business – so the researchers have to establish a good network of relationships with the locals so that their work can be a more sustainable thing.”

L Ê N A B Ù I

Research centreOxford University Clinical Research Unit

Established1991

Key research areas

diseases, HIV and HIV coinfections, CNS infections, animal health and zoonoses, pharmacology, clinical trials, statistics, bioinformatics, modeling, mapping

Employees300

Major research labs and field sitesHo Chi Minh City, Hanoi, Kathmandu (Nepal), Jakarta (Indonesia)

Lêna Bùi, Vietnam 2120

Is there an ethical dimension to the way we interact with animals, and how do our interactions with other species help shape our concepts of health and wellbeing? !is is where science fails us, and we must look to artistic expressions to enrich our understanding and appreciation of these complex relationships.

Lêna Bùi spent several weeks working with our research group in Vietnam, exploring and visiting "eld sites where we are conducting research on zoonotic diseases and the so-called ‘animal–human interface’. Our research programme involves working with communities of farmers, animal traders and market workers – people with high levels of occupational exposure to animals. Whether these folk who have intimate and prolonged contact with animals are truly at higher risk of zoonotic infections than more urban populations is one of our central questions. As scientists interested in disease transmission from animals to humans, we "nd it self-evident that behaviours relating to food consumption

and farming practices (especially handling of diseased animals, and activities involving slaughtering and processing of meats) are of singular importance. But how can we understand how these interactions with animals shape and in$uence our lives, our sense of who we are, of where our food comes from, and what is safe to put on our plates?

Most of our research participants are smallholder farmers who raise poultry and pigs. Some work in wet markets or slaughterhouses. Some are involved in the rodent trade or farming unusual species such as porcupines. Lêna came with our project team to recruitment meetings, to farm sampling trips and to slaughterhouses during the middle of the night. (Slaughterhouses are only operational at night, due to lack of refrigeration and the need to distribute fresh carcasses immediately in the morning to wet markets.) Lêna also went further a"eld, to visit intriguing and highly specialised communities in other parts of

Vietnam – small villages that have long histories of economies based on harvesting bird feathers or bat guano, and communities of farmers that raise swiftlets to harvest their nests as a delicacy. She had a keen sense of how to "nd exotic settings, examples of ‘intimate’ and ironic human–animal contact, and then represent them in di#erent media. !ere is no doubt that lifestyles in Vietnam are rapidly changing, and the intimate contact of humans with animals is one of the aspects of culture that will likely be lost to modernity. It remains to be seen how these changes will in$uence our perceptions of health and beauty, and what is natural, ethical or tasty. Lêna’s work may help us to re$ect on these changes before some of these traditional lifestyles become museum artefacts.

Juliet Bryant is a virologist at the Oxford University Clinical Research Unit, Vietnam.

There are few things more personal than people’s attitudes towards what they put on their plates. Dinner-table conversations about who has consumed the most exotic foods are standard fare for any exchange between travellers. Although friendly comparisons about consumption of rodent meat or crickets, pig intestines or bovine testicles sometimes lead to discussions about health risks and disease, the discussions rarely delve into attitudes about animal rearing and husbandry practices.

L Ê N A B Ù I A N D T H E A N I M A L " H U M A N I N T E R F A C E

J U L I E T B R Y A N T

Far right: Voracious embrace III (of III), 2012. Charcoal, ink and watercolour on paper. By Lêna Bùi.

Below: Detail from Eat by Faith, 2012. 21 digital photographs on aluminium. By Lêna Bùi.

Near right: The rest area in Triêu Khúc, the ‘feather village’, where

Where birds dance their last. From left to right: Huy (sound recordist), Ms Hien from the village and Lêna Bùi.

22 Lêna Bùi, Vietnam 23

Where birds dance their last (still), 2012. By Lêna Bùi.

24

Pata Picha Studio Photograph, 2012. One of a series of

Kenya. By Miriam Syowia Kyambi and James Muriuki.

Miriam is a multimedia artist of Kenyan and German heritage. Her work combines performance with impermanent and permanent media including clay, sisal, paint and photography. Much of her work interrogates and questions perception and memory. She examines how the contemporary human experience is in$uenced by constructed history, past and present violence, colonialism, family and sexuality. Often the result is an orchestration that engages the viewer in a dynamic process that leaves behind a powerful visual impression. Miriam graduated with a Bachelor of Fine Arts degree from the School of the Art Institute of Chicago, USA (2002). She has been the recipient of several prestigious awards and grants and her work has been shown in Belgium, Finland, Kenya, Mali, Mexico, South Africa and the USA.

James is a Nairobi-based art practitioner primarily working with photography, video and sound. His works explore transitions in the social landscape, particularly in the development of rapidly evolving urban spaces. He uses forms such as architecture and constructions as visual elements and metaphorical symbols that ask questions of the viewer. His work has been exhibited and collected in many countries and included in several publications. He has also collaborated with artists, attended residencies and workshops, and curated several exhibitions in Nairobi and abroad.

Both Miriam and James are interested in understanding the connections between personal and communal histories. While in residence, they worked in collaboration to investigate how health researchers and the involved community depend on and perceive one another. What happens when di#erent values, ethics and belief systems come into contact? Can these di#erences be negotiated?

One of the outcomes of their residency was the Pata Picha Studio. ‘Pata Picha’ means ‘get the picture’ in Swahili. People in Kili" town were invited to have their portraits taken alongside various props. !ese props were chosen for their connection with major themes identi"ed as in$uencing research: education, beliefs, context, exploration, money and power.

K E N Y A M I R I A M S Y O W I A K Y A M B I A N D J A M E S M U R I U K I

“ If I’m living in Kilifi and my life has been spent there… then all of a sudden these people come asking for things that perhaps for my community are deemed to be very deeply human… like blood, or spittle, urine samples or breast milk, then it’s very, very unusual, and I’d be very highly suspicious.”

J A M E S M U R I U K I

Research centreKEMRI (Kenya Medical Research Institute)–Wellcome Trust Research Programme

Established1989

Key research areasMalaria, HIV/AIDS, pneumonia, malnutrition, health systems research, social science and ethics, haemoglobinopathies, non-communicable disease, maternal and child health, immunisation

Employees800

Major research labs and field sitesKEMRI Centre for Geographic Medicine

collaborations in Tanzania, Uganda, Sudan and Somalia

26 Miriam Syowia Kyambi and James Muriuki, Kenya 27

Top left: Conjure Ruins III, 2012. From a series of photographs taken

Miriam Syowia Kyambi and James Muriuki.

Bottom left: Conjure Paths, 2012. From a series of photographs

By Miriam Syowia Kyambi and James Muriuki.

Advertising the Pata Picha Studio

Hospital (which sits next to the KEMRI research centre).

Middle right: Miriam and James in discussion with microbiologist Salim Mwarumba.

Bottom right: Ganze district (one of the areas KEMRI works in).

!is district hospital in coastal Kenya gets support from research funding. !is helps to ensure that most equipment is functioning, essential drugs are available, paediatric services are provided free of charge, and there is a well-resourced High Dependency Paediatric Unit for critically ill children. !e funding is also used to ensure that relevant research is conducted appropriately.

!ere is a dilemma however in how to describe and discuss this support with local residents. Would over-emphasis on this support raise expectations that cannot be met? Would it lead to further perceptions of the research organisation as a provider of aid, and therefore in$uence potential participants to join research without considering what it involves and its implications for them? !e messiness of these and other ethical dilemmas, and how to work with them, stands in stark contrast to the highly structured and systematic methods that are so central to the success of much biomedical research.

Research at the KEMRI–Wellcome Trust Research Programme spans over 23 years. !e connections we have established between researchers, health professionals, participants and patients contribute to how that research is experienced, interpreted, understood, and woven into daily conversations and activities and into local belief systems. So when researchers talk of blood samples, of various types of tests, of illnesses and technologies, of DNAs and genes, these are not necessarily understood as intended but are interpreted within wider cultural and traditional belief systems, and with a view to the motivations and trustworthiness of the people and institutions giving the explanations. Working in this region means being aware of these sensitivities, being open to critique, and understanding that biomedical systems are only one of many belief systems people draw upon.

So how do researchers understand the issues and bridge the gaps? Where does one start from? When and how can national and international guidelines and norms help? Community engagement activities at the Programme are aimed at answering these questions through involving local communities, and learning from our own experience and from others conducting or thinking about research in similar settings. !e outcomes of James and Miriam’s residency add an enriching external gaze to the complexities of the everyday lives of those involved in research, and add insights into the intricacies and realities that research engenders for all those involved.

Dorcas Kamuya is a researcher at the Ethox Centre, University of Oxford, and is largely based at the KEMRI–Wellcome Trust Research Programme, Kenya.

It is 12.30pm, and the blisteringly hot tropical sun and humidity are unrelenting. As if on cue, a distant bell rings and a crowd surges into the hospital wards, occupying every available space – the main walkways, the nurse stations in every ward, even the corridors between beds. The sound is overwhelming, the noise amplified by children crying and kanga-clad mothers shushing, laughing or crying. Some just watch on, quietly and solemnly. It’s visiting time at the hospital. The kaleidoscope of colours, conversations and emotions can be overwhelming for anyone new to this setting – an experience shared and covered vividly by James Muriuki and Miriam Syowia Kyambi whilst in residence here in Kilifi.

M I R I A M S Y O W I A K Y A M B I A N D J A M E S M U R I U K I : T H E I N T R I C A C I E S A N D R E A L I T I E S O F R E S E A R C H

D O R C A S K A M U Y A

28

Top left: Malaria and Melioidosis, 2013. Shadow installation. By Wandering Moon.

Top right and centre: Scenes from B-Floor Theatre’s performance of Survival Games.

Bottom left: Backstage with Wandering Moon Shadow Theatre.

Bottom right: B-Floor Theatre.

B-Floor !eatre is !ailand’s vanguard physical theatre company. For over 13 years, they have been at the forefront of creating highly visual theatre that combines movement and multimedia elements, and stimulates social and political awareness. B-Floor’s performances often involve little or no script, focusing instead on sensory storytelling that can communicate across borders of language and culture. !ey have not only enjoyed success in !ailand but also impressed international audiences in the USA, France, Denmark, Egypt, India, South Korea, Singapore, Taiwan and Japan.

While in residence, B-Floor travelled to a number of the centre’s rural research units as well as the headquarters in Bangkok. !ey were particularly struck by the multiple layers involved in the research processes they observed and also by the di#erent perspectives and shifts in scale that they encountered in each location.

!eir response was to devise a performance piece that re$ected these complexities in a highly visual, episodic collage illustrating the inextricable coexistence of the human population with microscopic pathogens. Produced in collaboration with the shadow theatre company Wandering Moon, Survival Games was a humorous interpretation of the endless struggle between humans and ever-mutating diseases, driven by the innate survival instincts of both.

T H A I L A N D B " F L O O R T H E A T R E

“ We spoke to one woman who’s been studying malaria for nearly nine years and she said that the disease itself, the way that it mutates inside the cells, is quite beautiful. There seems to be a respect and sometimes even an admiration that the scientists will have for these organisms that they’re dealing with.”

N A N A D A K I N , B ! F L O O R T H E A T R E

Research centreWellcome Trust–Mahidol University–Oxford Tropical Medicine Research Programme

Established1979

Key research areasMalaria, melioidosis, leptospirosis, cryptococcus, rickettsial infections, microbiology, pharmacology, mathematical and economic modelling, clinical trials

Employees600

Major research labs and field sitesBangkok, Mae Sot, Ubon Ratchathani, Vientiane (Laos), Siem Reap (Cambodia)

30 B-Floor !eatre, !ailand 31

From left to right: A village in Pailin province, Cambodia, where malaria is endemic; Shoklo Malaria Research Unit in Mae Sot, Thailand; B-Floor Theatre visiting a village in Pailin province; Sasapin Siriwanij and Nana Dakin of B-Floor in the Bangkok headquarters of the research centre (Sasapin is wearing an Alice monitor, which displays information about heart, lung and brain function).

Our work in Bangkok aims to understand how pathogens harm and kill people, and how to stop that. One of the challenges is the diversity of culture and language where we do research. At the Shoklo Malaria Research Unit on the !ai–Myanmar border, nine di#erent languages are spoken by the refugee community, and in our

Bangkok headquarters we have 24 nationalities working on projects. Ubon Ratchathani, in the north-east of !ailand, has the highest rate in the world of melioidosis, a potentially lethal bacterial infection a#ecting rice farmers who pick up the germ from the soil. We try to explain to people in the hospital with melioidosis that we want to collect and study their blood to make progress towards designing a vaccine against their disease. People in this region speak the Isaan language and this can create hurdles to communication.

Art presents opportunities to transcend language barriers and communicate ideas. Last year, B-Floor !eatre became artists-in-residence at our workplace

and I spent quite a bit of time with Nana, Kage and several other members of the B-Floor company. It was a privilege to spend time with such smart, curious and articulate people. !ey were eager to learn all they could about my subject, immunology, and after a while I found myself being led to explain advanced immunology.

My work is to explore how the human immune system responds to tropical infections such as malaria, scrub typhus and melioidosis, which are major global causes of death and disease, and to discover how we can use that knowledge to design vaccines against them. My team’s research focuses on how our cells learn to distinguish harmful foreign proteins from harmless self proteins.

During their residency, B-Floor ended up coaxing me to explain T-cell development, antigen recognition and presentation, and memory responses. Despite their arts background (not to mention conversing in a second language) they seemed to me to learn immunology better than many Oxford medical students I have taught! !ey were driven by a passionate urge to understand, and to ask fundamental questions about evolution and the survival of man, mosquito and bug.

A huge crowd of us went to see B-Floor’s "nal production, Survival Games, in Bangkok. We were very impressed by the interpretation of our work as a battle for survival – by the bugs that invade, by the humans who are infected,

and by the scientists who seek to uncover the truth and to evolve their own careers. !e rural communities where we work were shown to be the centre of the story, and diseases such as melioidosis were explained in a hugely entertaining way. We enjoyed the tender mockery of our nerdy passion for the bugs we study. Overall it was a greatly enhancing experience for us to be involved in this production.

Susanna Dunachie is a clinician and researcher at the Wellcome Trust–Mahidol University–Oxford Tropical Medicine Research Programme, !ailand.

The soil beneath our feet contains thousands of species of bacteria, and the mosquito buzzing past many of the world’s inhabitants may have up to 50 000 malaria parasites in its salivary glands. The survival of people, germs and the vector go-betweens is both a wonder and a puzzle.

B " F L O O R T H E A T R E A N D I M M U N O L O G Y

S U S A N N A D U N A C H I E

32 Zwelethu Mthethwa and the Mtubatuba Workshop, South Africa 33

Top: Zwelethu Mthethwa photographing the former local king, Mkhwanazi Omkhulu (left), the current local king, Muz’okhulayo Mkhwanazi (middle), and Qhina Mkhwanazi (right).

Middle: The local sangoma (traditional healer), L T Mncwango.

Bottom: Detail from one of the photographic workshops in which ‘good health’ was settled on as a theme.

Zwelethu Mthethwa is an artist based in Cape Town, best known for his large-format colour photographs. He is interested in work that raises diverse questions and in providing a di#erent perspective on the realities of post-Apartheid life. His work challenges the conventions of both Western documentary and African commercial studio photography through collaboration with his subjects.

While in residence, Zwelethu explored the role that communities play in contributing to the research of the Africa Centre. He was interested in putting a human face to the collection of data and in giving people the opportunity to document their own perceptions of health.

One of the outcomes of his residency was the Mtubatuba Workshop, during which basic lessons in photography were given to students, many of whom had never handled a camera before. !ey were then instructed to go out into their communities and produce a series of photographs that explored the theme of ‘impilo engcono’ – good health – a refreshing change for a population more usually identi"ed with its high levels of HIV. Not only did the workshop provide the students with an opportunity to develop new skills, it was also an exercise in empowering the next generation and enabling them to rede"ne themselves and their community.

S O U T H A F R I C AZ W E L E T H U M T H E T H W A A N D T H E M T U B A T U B A W O R K S H O P

“ Being behind the camera gives one control, the same as writing and other forms of art, one feels empowered. I got a chance to tell my story and my community’s story. I wanted to show the world what I feel is beautiful in my community.”

L U N G A N I N D W A N D W E , M T U B A T U B A W O R K S H O P P A R T I C I P A N T

Research centreAfrica Centre for Health and Population Studies, University of KwaZulu-Natal

Established1998 (activities started in 2000)

Key research areasPopulation-based research (socio-demographic surveillance at household level, HIV epidemiology and modelling, molecular epidemiology, demography, non-communicable diseases), social sciences, clinic-based research (HIV treatment and care, TB and HIV co-infections, mental health), health systems research and implementation, HIV virology (transmission, genetic evolution, immune pathogenesis), HIV bioinformatics.Number of employees360

Research labs and field sitesLaboratory facilities are in the University of KwaZulu-Natal Nelson Mandela Medical School in Durban. The Centre’s demographic surveillance area encompasses a 435 km2 rural area, home to around 90 000 Zulu-speaking people in 11 000 homesteads.

34 Zwelethu Mthethwa and the Mtubatuba Workshop, South Africa 35

!ese nine photographs acknowledge the contribution of the Mtubatuba community to this work. !ey are drawn from a larger body of work created by young people who attended a photography workshop run by Zwelethu Mthethwa whilst he was in residence. Everyone was given a camera and some basic lessons and sent out into their communities to explore the theme of ‘impilo engcono’ – good health. !is was a refreshing change for a population more usually identi"ed with its high levels of HIV. And the young photographers were now collecting their own ‘data’. !e images provide direct insight into the lives of local residents and make fascinating intersections with the health research of the Centre.

Humour is a dominant theme, evident in Fun Day (Sizwe Magcaba) and the playfulness of young boys in Inventors (!abile Portia Mnyeni). !is brings to mind the resurgence of hope in the community due to the decrease in mortality following the large-scale roll-out of antiretroviral drugs. !is lightness or positivity is also evident in the smiles of the young women in white of Innocence who are dressed for church (Khumalo Sinethemba). Christianity is prevalent in the local community, a theme echoed in the cruci"x worn by the girl of Crossing Paths (Lungani Ndwandwe) and the boy of Save Me (Sebenzile Nkwanyana), who is also dressed for church. !is boy carries a condom, an awareness of contraception, which could well be related to the work of the Centre and its community engagement programme.

In Splash (Sanele Mbokazi), the youngster is smiling broadly but his small bathtub points to one of the biggest local health challenges: water. !e Africa Centre’s

research has found that due to the short supply of clean running water, it is safer for a child who is HIV negative to breastfeed from their HIV positive mother than to drink formula milk, provided the mother is on antiretrovirals and adhering to the relevant guidelines on preventing mother-to-child transmission. Lack of running water points to the poverty and daily struggle experienced by many in this community. !is struggle is evident in the stance of the woman of Working Mothers (Mpumelelo Mkhwanazi), who stands in a dusty, desolate environment, painted in mud to protect herself from the scorching sun.

Amidst this struggle and poverty, one is surprised to "nd the yoga practitioner of Vinyasa Flow 2 (Nothando Sabela). !is young yogi was taught by one of the Africa Centre’s researchers, an anthropologist, who developed a close bond with this particular family through her research in 2010. !is image was a real favourite in South African exhibitions (which took place in Cape Town and St Lucia, KwaZulu-Natal) and is an example of how these artworks can serve to re$ect local cultural diversity and to link the lives of the community with the datasets of the Centre.

Tulio de Oliveira is Professor of Genomics and Bioinformatics and Astrid Tre#ry-Goatley is an ethnomusicologist, both at the Africa Centre for Health and Population Studies, South Africa.

Preventing HIV transmission calls for a deep understanding of the HIV epidemic. The cornerstone of our research programme at the Africa Centre is a biannual household demographic survey that, since 2000, has collected data on births, deaths, marriage and migration events, as well as household economics. The survey covers a population of around 90 000 people in 11 000 households. An additional annual HIV surveillance study, established in 2003, collects samples that are used for health research, and applies virological, genomic and bioinformatic methods to understand HIV transmission and resistance to treatment.

M T U B A T U B A W O R K S H O P # P U T T I N G A H U M A N F A C E T O D A T A

T U L I O D E O L I V E I R A A N D A S T R I D T R E F F R Y ! G O A T L E Y

Top left: Crossing Paths. By Lungani Ndwandwe.

Bottom left: Save Me. By Sebenzile Nkwanyana.

Right: Innocence. By Khumalo Sinethemba.

Above: Vinyasa Flow 2. By Nothando Sabela.

Left: Working Mothers. By Mpumelelo Mkhwanazi.

Above left: The Fountain. By Siboniso Bhekumusa Sibiya.

Above right: Fun Day. By Sizwe Magcaba.

Below left: Inventors. By Thabile Portia Mnyeni.

Below right: Splash. By Sanele Mbokazi.

36

Fossil Necklace, 2013. 170 carved, rounded fossils, spanning geological time. By Katie Paterson.

Katie Paterson is a Scottish artist, based in Berlin. Her conceptual projects make use of sophisticated technologies and specialist expertise to stage intimate, poetic and philosophical engagements between people and their natural environment. Since graduating from the Slade School of Fine Art in 2007 she has gone on to exhibit internationally, from London to New York, Berlin to Seoul, and her works have been included in shows at major venues such as Tate Britain in London, Vienna’s Kunsthalle and Sydney’s MCA. Her artworks are represented in collections including the Guggenheim New York and the Scottish National Gallery of Modern Art in Edinburgh.

While in residence, Katie immersed herself in genomics research. She became particularly interested in ideas of genomic archaeology, human variation and human evolutionary history. !e fossil record, combined with DNA analysis of current species, enables us to build a picture of our planet’s biological history.

!e outcome of her residency, Fossil Necklace, charts the development of life on Earth. Each of its 170 beads, carved from individual fossils, represents a major event in the evolution of life. !e "rst beads are billions of years old and relate to the beginnings of single-celled organisms. !e "nal beads trace the emergence and routes of human beings and our ancestors across the globe. It is a powerfully tangible reminder of our deep-rooted connections with each other and other species.

U N I T E D K I N G D O M K A T I E P A T E R S O N

“ It’s important to be able to make a connection between ourselves and other life forms… to have a larger sense of where we fit into the grand scheme of our planet and the rest of the universe.”

K A T I E P A T E R S O N

Research centreWellcome Trust Sanger Institute

Established1993

Key research areasHuman genetics, pathogen genetics,

genetics, bioinformatics

Employees1034

Major research labs and field sitesThe Sanger Institute is on the Wellcome Trust Genome Campus in Cambridge and its research involves collaboration with scientists working in the UK and overseas

38 Katie Paterson, United Kingdom 39

Fossils and DNA both provide partial glimpses of the same tree. !e information is complementary. From DNA, we can make inferences about the ancestors of the individuals or species we sequence. Fossils show us what species were around at any particular time in the past, whether or not they now have descendants among living species.

!e Sanger Institute has been involved in sequencing the DNA of several species whose ancestors are represented on Katie Paterson’s Fossil Necklace. One of these is the pig. !e "nal bead in the Oligocene period comes from a Peccary ‘skunk’ pig who lived 30 million years ago in

South Dakota, USA, while we concentrate on the Duroc breed of the modern domestic pig. !e DNA sequence shows just how powerful the sense of smell is in pigs, and how complex the origins of the domestic pigs were.

My main interest is in human evolution, and many of the more recent beads link to our lineage. As Darwin speculated, human origins are in Africa and our ancestors split from chimpanzee ancestors 6–7 million years ago, a time and place re$ected in the Miocene bead constructed from glowing Kenyan Miocene amber – fossilised resin from ancient forests where these ancestors may have resided.

Fully modern humans evolved very recently, less than 100 000 years ago, again in Africa. It is perhaps "tting that the "rst bead on Fossil Necklace was found in the same vicinity, containing extremely early single-celled microorganisms, the "rst signs of life on Earth billions of years ago, with whom we humans share our basic genetic code.

Genetics shows that all non-African humans are descendants of a single group who expanded out of Africa around 60 000 years ago and colonised the rest of the world. Devastation and ecosystem collapse invariably followed our arrival. Humans reached Australia 50 000 years ago and extinctions of large animals (megafauna) occurred 46 000 years ago. Katie obtained a fossil from an extinct kangaroo to represent this; appropriately,

perhaps, it crumbled, and there is no kangaroo bead. But there is the mud lobster bead, a species that survived the megafauna extinction only to be driven to endangered status by our own generation. !e story is the same in Europe and in the Americas, where human entry around 15 000 years ago was followed by megafauna extinctions a few thousand years later. !e bead from a Texan horse represents one of the last survivors of the native horses of America.

We humans are not a pinnacle of evolution, but we have a#ected our planet in a way that no other species has done – and we are the only species who can make art that re$ects upon our journey.

Chris Tyler-Smith is head of the Human Evolution team at the Wellcome Trust Sanger Institute.

Fossil Necklace, 2013. By Katie Paterson.We can all appreciate how fossils can be transformed into

beads on a necklace to become a work of art. But how does genetics, which is what we study at the Sanger Institute, fit in? The answer is actually simple: DNA. To appreciate this link, consider the following ideas. Every individual living now traces their origins (and DNA) back through an unbroken chain of ancestors to the origin of life. There really is a ‘tree of life’ linking every living and extinct species. In the past, the only way to reconstruct this tree was using anatomy, from living species and especially from fossils. Now we also do it using DNA: the more similar the DNA, the closer the species are on the tree.

K A T I E P A T E R S O N A N D E V O L U T I O N

C H R I S T Y L E R ! S M I T H

40 Katie Paterson, United Kingdom 41

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Origin of life on Earth

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Origins of agriculture

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Modern humans in the Americas

Modern humans in Siberia and Europe

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PLIOCENE 5.3 – 2.6 MYA MIOCENE 23 - 5.3 MYAOLIGOCENE 34 - 23 MYA

EOCENE 55 - 34 MYA

CRETACEOUS 145 – 65 MYA

TRIASSIC 252 – 201 MYA

PERMIAN 299 – 252 MYA

CARBONIFEROUS 359 – 299 MYA

DEVONIAN 420 – 359 MYASILURIAN 443 – 420 MYAORDOVICIAN 490 – 443 MYA

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Children from Mawila Primary School, Chikwawa, Malawi, who participated in a workshop coordinated by Elson Kambalu. The children created works in response to discussions about health research and the work of the local hospital.

42

Wellcome Collection would like to thank all the artists, without whom this exhibition would not have been possible.

We would also like to thank the following:

Siân Aggett, Ken Arnold, Sophia Austin, Danny Birchall, Zoe Butt, Mary Chambers, Phaik Yeong Cheah, Tamara Chipasula, Rachel Collins, Nick Day, Richard Ellis, Jeremy Farrar, Elizabeth Fisher, Ruth Garde,

Barry Gibb, Philomena Gibbons, Robert Heyderman, Elayne Hodgson, Jane Holmes, Sam Hopkins, John Imrie, Dorcas Kamuya, Catherine Kenyatta, Sabien Khan, Siobhan Maguire, Mduduzi F Mahlinza, Kevin Marsh, Dan Maslen, Clare Matterson, Marie-Louise Newell, Michael Parker, Peter Piot, Elizabeth Pisani, Steve Scott, Astrid Tre#ry-Goatley, Jonathan Truslow, Bow Wasinondh, Jimmy Whitworth, Julia Willingale-!eune

E L S O N K A M B A L U

!e Story of Medicine and Disease in Malawi, by Michael and Elspeth King

AIDS Artists and Authors: A look at creative art responses to AIDS, by Steve Chimombo

Folklore, Gender, and AIDS in Malawi: No secret under the sun, by Anika Wilson

Powers of Culture, by John M K Mtitima

M I R I A M S Y O W I A K Y A M B I A N D J A M E S M U R I U K I

General History of Africa (8 vols), published by Heinemann/Unesco

African Religions and Philosophy, by John S Mbiti

B ! F L O O R T H E A T R E

Games for Actors and Non-Actors (2nd edn), by Augusto Boal, translated by Adrian Jackson

!e Frantic Assembly Book of Devising !eatre, by Scott Graham and Steven Hoggett

!e Way of Acting, by Tadashi Suzuki, translated by J !omas Riner

L Ê N A B Ù I

Guns, Germs, and Steel, by Jared Diamond

Emergence: !e connected lives of ants, brains, cities, and software, by Steven Johnson

Decoded Messages: !e symbolic language of Chinese animal painting, by Hou-mei Sung

Z W E L E T H U M T H E T H W A A N D T H E M T U B A T U B A W O R K S H O P

AIDS, Intimacy and Care in Rural KwaZulu-Natal, by Patricia C Henderson

Zulu Medicinal Plants, by Anne Hutchings

K A T I E P A T E R S O N

!e Ancestor’s Tale: A pilgrimage to the dawn of life, by Richard Dawkins

Human Evolutionary Genetics, by Mark Jobling, Edward Hollox, Matthew Hurles, Toomas Kivisild and Chris Tyler-Smith

G E N E R A L

An Anthropology of Biomedicine, by Margaret Lock and Vinh-Kim Nguyen

Turning the World Upside Down: !e search for global health in the 21st century, by Nigel Crisp

Global Health: An introductory textbook, edited by Hans Rosling

When People Come First: Critical studies in global health, edited by João Biehl and Adriana Petryna

World Art Studies: Exploring concepts and approaches, edited by Kitty Zijlmans and Wilfried Van Damme

!e One and the Many: Contemporary collaborative art in a global context, by Grant H Kester

Education for Socially Engaged Art, by Pablo Helguera

Global Studies: Mapping contemporary art and culture, edited by Hans Belting, Jacob Birken, Andrea Buddensieg and Peter Weibel

A C K N O W L E D G E M E N T S

F U R T H E R R E A D I N G

In 2012, Wellcome Collection commissioned six artist residencies in medical research centres around the world. Artists were invited to spend at least six months exploring the activity of researchers basedin Kenya, Malawi, South Africa, Thailand, Vietnam and the United Kingdom and to produce new work in response to their experiences. Foreign Bodies, Common Ground brings together some of theextraordinary outcomes of these different journeys.

wellcomecollection.org/foreignbodies The free destination for the incurably curious

Exhibitions at Wellcome Collection 183 Euston Road, London NW1 Euston, Euston Square

Wellcome Collection is part of the Wellcome Trust. The Wellcome Trust is a charity registered in England and Wales, no. 210183. Its sole trustee is The Wellcome Trust Limited, a company registered in England and Wales, no. 2711000 (whose registered office is at 215 Euston Road, London NW1 2BE, UK). MP-5756.3/8K/10-2013/MD