“Koat phey khmaoch, châng moel’ (she is afraid of ghosts, so she wants to look), he said to me, not turning from his typing… The ward is not specialized in ghosts (there are other experts for those beings), yet doctors and nurses understood that patients might connect pain or a dream with a supernatural intervention that could result in a malady of the flesh. What was intriguing to me was that the ultrasound machine drew this woman and her friend to the hospital for a situation for which they could have gone to a monk or a krou, a traditional healer. Perhaps they visited them all.”(3)
Opening at the heart of the imagining ward of the Khemer-Soviet Friendship Hospital in the capital of Cambodia, Fixing Images: Ultrasound and the Visuality of Care in Phnom Penh stages a very mundane yet complex imagery of health care simultaneously. In the exam scene, the patient simply wants to know what she has in order to be cured. She wants to see. The intended visualization of a ghost’s absent presence becomes more than a tenuous fear or a superstition. Perhaps with a nuanced gesture, we can interpret as Derridean, ghost reminds us of the relational dynamic with I and the other, in this case, the body and the machine and the malady. She wants to understand her own body and be a part of the healing process. The ultrasound machine itself becomes a collaborator in this desire. The scene reveals that seeing requires mediation, navigation and always an other/others. Rather than being possessed by a single actor, the ability and the authority of seeing/knowing is shared by multiple agencies here – machine, doctor, krou, patient. Medicine meets not only with technology but also culture and belief. Ultrasound image creates a series of direct and indirect encounters, as well as heterogenous and partial ways of seeing and caring for self and others.
Traveling from imaging ward and the ER to gynecology, private clinics and many other public and private spaces, ultrasound, shortly echo in Khemer and French, is a very ordinary and common object of health care. This common and mobile visuality, however, as the opening anecdote manifests, is the exact departure point for cultural anthropologist Jenna Grant to discuss more. Suturing technology, care, medical image production, colonial and (post)socialist politics together around ultrasound technology’s journey in Cambodia since 1990s, Grant examines how (health) care is formed, reformed and formulated through intervention, negligence, repair, stability/instability – fixing as she conceptualizes it.
Throughout the book, Grant traces the genealogy of health care in Cambodia through medical technologies from the country’s independence in 1953 to present and investigates how people relate to ultrasound images – particularly the images in prenatal care and their aesthetics – and consequently how images relate to bodies. Grant’s fieldwork between 2009-2011 extends into a 10-year research with intervals and traverses archival research, artistic engagement and multimedia investigation (medical journals and art exhibitions).
Thinking with ultrasound, Grant interrogates how the public health system and infrastructure changes from independence to socialist and postsocialist times, and through privatization and marketing. Throughout this genealogy, technology takes different shapes and turns as it translates into white colonizer and an instrument of control over bodies in the colonial times; a sign of national independence in postcolonial times; and always a measure of modernity. Both its absence and presence (sometimes second-hand, sometimes donated), as well as its questionable presence (it’s there but not working, people don’t have the literacy to interpret it) create a care network. Patients, doctors, technology, technicians, distributors, imaging wards, government and hospital officials all become parts of this network of care. Grant focuses on how care is articulated and visualized among these things, beings, and spaces, and draws attention to the pressure and breaking points in health care.
Khmer as a language enables a very rich ground to discuss care. Although care has many iterations two stand out and are distinguished from each other: yok chett tuk dak (to take the heart and keep it close, safe’) -‘actions done with respectful attention’- (80), and an authoritative skill –whose encounter is inevitable porous. The ways in which ultrasound, the image see the bodies constitute a great part of an act of care. Touching upon Foucauldian medical gaze, and Feminist Science and Technology Studies and visual anthropology’s problematization of seeing, Grant also references colonial and Buddhist practices seeing and how they interfere with the conventional ‘medical gaze scripted into the machine’ and how interference itself is the way of seeing in the first place (105). Grant here draws attention to the Khmer word moel, which has multiple meanings like seeing, understanding, examining and caring. Moel is not only about looking and things but also about figuring out how to look at them. And, it is an important word/act of traditional healing. In Buddhist practice seeing is not limited to the eye, there are more-than-visual ways of seeing. As Grant discusses, this gesture invites us to understand medical image and the body not only through the constrictions of medical discourse but also a series of entanglement and shared responsibility between human and more-than-human bodies.
Fixing Images cares about medical technologies and images while showing how medical technologies and images care. Being inseparable from one another, both care and seeing become a matter of encounter between different positionalities and spaces rather than defining and figured by certain hierarchies between human and more-than-human or subject and object.
Grant, Jenna. Fixing Images: Ultrasound and the Visuality of Care in Phnom Penh. University of Washington Press, 2022.