Government officials worry that epidemics of Third World diseases, whether spread accidentally or disseminated deliberately by terrorists, could produce widespread death. Agencies such as the U. Department of Defense and the Centers for Disease Control have created units to plan for the threat of bioterrorism, which security analysts in the United States commonly cite as the new clear and present national danger.
- Document - Cholera outbreak
Postal Service and killed five persons in the fall of , these fears came to life as people opened the daily mail and watched the evening news. Emerging and "re-emerging" diseases are tied to anxieties that deadly germs are passing from Asian, African, and Latin American bodies and environments into white bodies, anxieties that are exacerbated by talk of immigration and population increase. Race and class clearly lie at the core of these fears.
The Importance of Narrative The story of the cholera epidemic in Delta Amacuro is not a simple tale of Machiavellian conspiracies or evil power mongers who gleefully marked others for death. It is, rather, a story of well-trained professionals who, in general, took their obligation to protect the health of the public quite seriously.
It is not a tale of a backward, Third World country where callous officials were ignorant of or unconcerned with modernizing health care. The citizens of oil-rich Venezuela have long prided themselves on being a shining example of democracy and modernity in Latin America. Medicines, techniques of diagnosis and treatment, technologies, manuals, statistics, reports, and interpretations are transnational, moving rapidly among public health institutions around the world. Images of Latin America cholera patients began to circle the globe in reports issued by WHO and the Pan American Health Organization PAHO as soon as the first cases were reported in Peru in January , and they found their way into government agencies and newspaper articles and television reports.
Descriptions of cholera patients were circulating in Venezuela ten months before Vibrio cholerae crossed the border, affecting how Venezuelans perceived the disease and the people it infected. Ideologies and practices of social inequality—particularly ways of perceiving and relating to persons in terms of their ability to internalize modern hygiene and biomedical conceptions of health and disease—were disseminated at the same time.
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Clara and I listened for years to the ways that individuals in a host of settings talked about the cholera epidemic in Delta Amacuro, Venezuela, and Latin America. Each story created a dramatis personae, a series of events, and a set of causal inferences.
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Each depicted some parties as heroes who acted wisely and courageously, others as villains who promoted death for their own gain or glory, and still others who were pathetic bystanders not smart enough to get out of the way. Cholera stories circulated among employees in the public health sector, from the state director to physicians and nurses in small rural clinics, and they were also told by people who survived the illness and relatives and neighbors of those who did not.
Vernacular healers, politicians, officials in government agencies, political activists, entrepreneurs, soldiers, journalists, and the people in the street also told cholera narratives. Stories circulated throughout the region with incredible rapidity. Governors, public health officials, taxi drivers, and patients frequently told the same narratives, albeit in different ways.
It is, of course, not simply the content of cholera narratives that rendered them potent. Until stories are retold, they have little impact.
It is crucial to ask how stories circulate. Which stories became part of official statements by regional, national, and international public health authorities? Which accounts of cholera made it into the regional and national press? How were explanations of cholera morbidity and mortality—who gets infected and who dies—retold in policy statements? And how were stories that provide alternative explanations kept from circulating or denied legitimacy?
In examining the mechanisms through which stories were produced, transmitted, imbued with legitimacy, and challenged, we see that narratives had very real effects on how people live and die. Wasn't it more important to figure out why people were dying and what could be done to prevent additional deaths? The problem is that stories are just as real as germs and bottles of rehydration solution. Stories reported by the media were particularly powerful.
Accounts in Caracas newspapers included what reporters saw and heard on the streets of Tucupita. Their stories put public health institutions on the line. They forced officials to act. Nevertheless, by constantly quoting public health officials and using their statements, journalists shaped the language that came to characterize the epidemic and inadvertently confirmed these officials' status as the sole authoritative source of information regarding the epidemic.
Alternative stories, including those told by people living in the most deeply affected communities, became nearly invisible.
Exchanging narratives was a means of dealing with anxiety for all parties, but the nature of the anxiety differed widely. For some, particularly for the relatives and neighbors of people who died, stories that explored "why we are dying" constituted means of trying out strategies for survival, attempting to obtain resources and medical assistance, and dealing with the widely expressed fear that "all of us are going to die! To be sure, cholera stories varied widely. Nevertheless, narrators tended to view the epidemic either in terms of its broad social, political, and historical factors or as a medical and epidemiological phenomenon.
For those who adopted the first strategy, the epidemic thus took its place among stories of racism, labor exploitation, land expropriation, human rights violations, transnational commerce, environmental degradation, and international conflict. What people knew or learned about the Persian Gulf War, international commerce, and the environmental problems produced by transnational corporations deeply affected how they perceived and reacted to the disease.
According to this perspective, the sharp increases in social inequality produced by the Venezuelan economic crisis of the s had created expendable populations without access to health, economic well-being, or justice. According to this perspective, the fact that cholera was killing poor people of color should have surprised no one. These stories would suggest that cholera is a disease of modernity, globalization, and social inequality.
Other narratives treated cholera as a biomedical phenomenon that could be explained by the introduction and spread of Vibrio cholerae. These stories isolated the epidemic not only from the economic crisis but also from the way that racialization—a process of imbuing a broad range of phenomena for example, bacteria with racial meanings—structured access to health care, jobs, education, and other services.
These narratives were created largely by public health officials and disseminated widely by the media. They came to play a key role in shaping the ideologies that guided institutional practices. At the heart of these narratives and their ideological effects lay the anthropological language of culture. One of the major concerns of this book is the institutional use of cultural reasoning to blame poor populations for the devastating effects of racism and economic globalization, which is evident far beyond the rain forests of Delta Amacuro.
Cholera created a charged, high-stakes debate about the lives of the people it infected, and competing stories bore quite different policy implications. Some of these narratives cast people who suffered from the disease as modern subjects who demanded the political, economic, legal, and health rights they deserved.
If you accept these stories, the solution would seem to lie in ending institutional racism and making fundamental changes in how power and resources are distributed. If you believe the individualizing, cultural narratives, then there is little that can be done, since culture cannot be changed through legislation or institutional policies.
Cholera stories thus illustrate the dual significance of images of social inequality, serving both as representations of how poor people of color are placed within modernity and as a means of regulating access to jobs, education, legal protection, medical treatment, and capital.
In other words, in purporting to describe the lives of the poor, such discourses play a key role in shaping them. Given the role in fostering social inequality played by globalization, its moral and political legitimacy hangs in the balance. Because public health officials, reporters, and politicians believed that the blame ultimately lay in cultural difference, it was easier to adopt short-term policies aimed at ending the scandal than to move toward medical and social justice.
Pinned with the responsibility for branding Delta Amacuro as a backward, cholera-ridden region, they became even less welcome in the land they have occupied for centuries. Those who moved to the small cities near the fluvial area did so because they believed that they would never escape death in the delta.
In these cities they lived in the most inhumane conditions. Their lives are certainly no less "at risk" than they were during the epidemic—the nature of the risk has simply changed. The epidemic and the stories told about it point to the crucial importance of people's relationship to medicine, public health, and hygiene in determining the way they are treated by nation-states—in other words, in determining their status as citizens.
Although the language of citizenship has been connected frequently with questions of inclusion and equality, scholars have recently argued that it has often provided a framework for excluding or subordinating particular communities; accordingly, "citizenship has entailed a discussion, and a struggle over, the meaning and the scope of membership of the community in which one lives. Public health officials, physicians, politicians, and the press depict some individuals and communities as possessing modern medical understandings of the body, health, and illness, practicing hygiene, and depending on doctors and nurses when they are sick.
These people become sanitary citizens. People who are judged to be incapable of adopting this modern medical relationship to the body, hygiene, illness, and healing—or who refuse to do so—become unsanitary subjects. Once a population was cast into the realm of the unsanitary subject, the characteristics of race, class, and gender that seem to exclude them from the ranks of sanitary citizens often led to differential treatment of individuals who bore such characteristics by clinicians and public health professionals.
In analogy with the way drivers of color are often singled out in the United States for traffic stops and searches "racial profiling" , we refer to differences in the distribution of medical services and the way individuals are treated based on their race, class, gender, or sexuality as medical profiling.
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The implications of being relegated to the status of unsanitary subjects were profound, affecting people's access to the political, social, and civil dimensions of citizenship—and, ironically, to health care itself. Author as Narrator A reader's perception that a story "tells itself" is a powerful illusion created by the author, who extracts a story from the words of its narrator and the setting in which the story emerges.
Retelling cholera narratives plays a crucial part in shaping their social and political impact.
By resituating so many stories in these pages, we too become part of the politics of the epidemic and of social inequality. So it seems only fair to tell my own story of how I became a part of this narrative process. Trained as an anthropologist, I conducted research in my home state of New Mexico for fourteen years, as both an activist and a scholar. There I concentrated principally on documenting ways that Spanish speakers, who often call themselves mexicanos, talk about the past.
I attempted to discern the role that such talk plays in communities that are fighting for cultural and political-economic survival. I first went to Delta Amacuro state in , drawn by the advice of Venezuelan colleagues who suggested that research on social dimensions of the predominant language used in the delta, Warao, and how it interacts with Spanish might be useful in bolstering programs in bilingual education and health care. The people who live in Mariusa had not previously welcomed a researcher into their midst.
Since very little Spanish was spoken there at the time, Mariusa proved to be an excellent place to improve my linguistic skills. In both areas I documented how social relations and power were shaped by the different ways that people used language in telling stories and in gossiping, giving speeches, mediating conflicts, teaching, asking for jobs and government services, and defending themselves against land expropriation, exploitation, and assaults on dignity and human rights.
A key focus was the role of speech, song, and therapeutic touch in vernacular medical practices.
I left in August , but I have returned to these communities nearly every summer. In a letter from a bilingual schoolteacher reached me in New York, bearing the forbidden word cholera. Newspapers published in Caracas ran stories on the outbreak, and subsequently other friends conveyed the news to me in letters, the occasional telephone call, and even an e-mail message or two. Conversations with anthropologists and others who had worked with Warao communities for decades countered this information. First I was told, "It's not cholera, it's just the normal diarrhea that kills Warao this time of year.
Later the story changed to "isolated cases of cholera. Except in areas where cholera has become endemic or where chlorinated water and sewage treatment are widely available, the chances of there being only "isolated cases" are few. My response was typically gringo: "Can't we do something? I can raise money to help with treatment and relief efforts.
I wasn't reassured.