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In June 2015, as Sierra Leone and Guinea was experiencing new surges in clusters of Ebola virus cases, Nature published a news article asking why an inexpensive test that “could save lives” was not being deployed to the field. Indeed, while it seemed obvious to many policy makers and health experts that Ebola rapid diagnostic tests were urgently needed, the question of how these objects should be implemented and used ‘in the field’ remained uncertain.

On January 17^th, 2018, participants from the UK, Europe, and India gathered in Edinburgh for “Investigating Diagnostic Devices in Global Health”, a workshop that also marked the launch of the ERC funded DiaDev project. Hosted by the DiaDev team, Alice Street, Ann Kelly, Nanda Kannuri and Eva Vernooij, the multi-disciplinary workshop

The origins of laboratory medicine are often traced to the establishment of a small clinical laboratory in Guy’s Hospital, London, in 1828. Here, in a small side-room, medical students used sterilisers, incubators and microscopes to identify bacteriological organisms in biological samples taken from the patients in the ward next door. In this simple removal of bodily fluid from the patient’s body and its transfer to a laboratory bench a few metres away, it is possible to see the ‘laboratory revolution’ that transformed European medicine in the mid-nineteenth century (Cunningham and Wiliams, 1992). With the rise of the laboratory, the site of production of medical knowledge and authority shifted from the hospital bed to the laboratory bench. Medical scientists and students identified diseases within disinterred organs, tissues and fluids, rather than the patient body, laboratory technology came to dominate medical practice, and the biological and experimental sciences exerted a new supremacy over clinical medicine.

Yet, in 2003 when I was a PhD student in social anthropology setting off to study the practice of biomedicine in Papua New Guinea’s public hospitals and clinics, the story of laboratory medicine told by European medical historians provided little insight to the everyday clinical work of doctors, nurses, or indeed laboratory technicians.

Having been left in the long grass for several years while donors, activists, governments and public health experts focused on the question of access to vital medicines, the issue of diagnosis is today at the very top of the global health agenda. The rise of diagnosis as a global health issue has tracked its reformulation into a question of access to diagnostic devices. A new wave of point of care, rapid detection, low-cost diagnostic devices has emerged as a multi-faceted solution to the poverty of laboratory infrastructures in resource poor settings, the high costs of treatment that follow from over-diagnosis, the burden of morbidity generated by diagnostic error and, increasingly, the imperative to monitor and evaluate the “impact” of globally funded public health programs. Tiny, modest-looking technologies, such as the new immunochromatographic rapid test for sleeping sickness that detects antibodies against Trypanosoma brucei gambiense in 15 minutes, are imbued with the promise of healthier, more economical and more equitable futures. Bilateral donors, philanthropic organisations, ministries of health, university researchers, and frontline health workers are all working hard to turn those promises into a reality.

But how much work can the diagnostic device itself do?