Joe Spence

PhD Student, Anthropology


"From the Cubby": Tuberculosis treatment in underserved populations

Joe's research addresses tuberculosis among patients experiencing treatment barriers such as drug addiction and homelessness. It takes form as a written dissertation and a feature documentary film called “From the Cubby”. Based on four years of fieldwork, it addresses the 1984 Public Health Control of Disease Act and the prospect of implementing Part 2A Court Orders as a resort to achieving compliance when patients are unable or unwilling to comply with authorities and self-administer medication.

Clinical outcomes are typically worse among patients whose socioeconomic conditions or lifestyles make it harder for them to recognise the onset of illness, self-administer medication or access support services. This held true when, whilst conducting fieldwork among rough sleepers and heroin users in Canterbury (South East England), several respondents became infected with tuberculosis. His written ethnography and co-produced documentary film examine the development of the cluster, and how health and social services mobilised to prevent contagion. It does so through the interwoven stories of three main protagonists, whose experiences evidence ongoing gaps in social care and barriers to treatment.

Joe's ethnographic works have been produced collaboratively with healthcare providers and former patients, among them a man called Nick. In 2017 Nick was an entrenched rough sleeper, addicted to heroin and suffering from the early symptoms of tuberculosis. In the year that followed Nick was hospitalized and then discharged into unsupported emergency accommodation with the duty to self-administer a six-month course of daily antibiotics. Complex and interrelated circumstances made it difficult for him to keep appointments and maintain his doses, leading to deteriorations of health, potential drug resistance, and the risk of infecting others. The situation escalated to the extent that Nick ended up being prosecuted by his local authority and forcibly detained in treatment facilities under Part 2A of the Public Health (Control of Disease) Act 1984. His case study provides unique insight into the use of legal controls such as Part 2A Orders as a mechanism towards disease control.

Working in a creative partnership, Joe and former research participants aim to contribute a resource that can be of practical assistance to service providers, to share lived experience of communicable disease and the attendant challenges of finding, diagnosing and treating 'hard to reach’ populations. The overarching aim is to build a platform for patient-led research, advocacy and action. “From the Cubby” and its integrated ethnographic dissertation will be premiered in 2022 and toured nationally as part of a programme of dedicated outreach events.

Joe Spence is funded by the ESRC 1+3 scholarship and has experience teaching. 

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