Basso (1996) Wisdom sits in Places.

Keith Basso. Wisdom sits in Places.
This is a very important piece of work in the literature of space and place. Its importance comes from the fact that it has engaged with cultural productions that were less considered in the anthropological approximation to how people live their worlds. For Basso, the act of name-placing and the name-worlds they imply was never really thought in depth. His focus in how “people speak with names” in the Apache experience in Arizona is what makes very compelling this book. It somehow resembles Bachellard’s ideas of the “poetic of space” and daydreaming we’ve seen last week but in a very different way. Here places are containers of wisdom and moral stories that people gain access in their everyday talks, when move through space, and when people are experiencing difficult situations. Basso is trying to show something that I guess is more present than we thought, how stories are emplaced, then spacialized, and reenact through spatial/temporal imagination. But there is a degree of depth one can say among these stories, some of them just “tell” or “recall” specific stories associated with topological and mnemonic forms of knowledge. But others have a “deeper” wisdom, according to Basso, when people “speak with names” they are relearning and embodying what the elders had done and, therefore, how people should or should not behave as a collective entity. These are moral cautionary tales sitting in places, ready to be perceived and apprehended by Apache people (or someone that has the capacity to perceive it such as Basso). I was trying to think about this idea of name-placing in my own society and see if I can find examples. I think people could say, “if you wear that dress you’ll end up in Godoy Cruz” (implying that you look like a travesti) or if a gay friend says, “I broke with my boyfriend and I went to Santa Fe and Callao” (implying he went to pick up a sex partner). But these two levels that Basso shows, the “surface” one which implies storytelling about specific places with particular associations, and the “deeper” one that involves strong sense of morality and even rules of what should or should not be done, are not easily ready to find in my mind when thinking on my own society. Still I consider that if we look with Basso’s eyes we may find these sorts of stories. The only problem I have with Basso’s accounts is quite obvious: his approach can be seen as essentialist, he is not so far away of Gupta’s and Ferguson’s critique to the usual idea of fixing people to places, the idea one people = one culture = one place. Only that he does it with a subtle approach. He has a very poetic and pragmatic way, he says these places, and the Apache way of naming them are constantly being created, it is an unstoppable process. But the problem I have is that not only wisdom sits in places, but ignorance too. I think Basso in his attempt to localize and highlight the name-placing process he somehow forgot to show the tactical and spontaneous use (in de Ceurtian’s terms) of places. It seems these are mythical and out-of-the-time places but they have particular histories and struggles not only between Apaches and the surrounding society, but also, and more importantly, among Apaches themselves like in the story of the family that did not want to share their corn and were enclosed in their home and have to shit inside. His linguistic and phenomenological approach leaves very few spaces for considering political struggles and conflicts among the Apache. It seems that everyone perceives the same and think the same (although he differentiate elder from youngsters, and more or less wise people) in relation with these places. I think overall Basso makes a very respectful and insightful analysis of Apache place-making and experience-sense of places and in doing so he moves into untransited cultural zones that problematize the relationship between the here and the past and the here and now. And as I said the only problem I’ve found is his tendency to flatten the social inner differences and to dissociate time from socio-political history (only certain forms of history are considered) in relation with those places.

crushed ice 2009 (these crazy guys...)

I liked this thing, people really crazy ice skating in the middle of quebec city....

Ayora-Diaz (2000) Imagining Authenticity in the Local Medicines of Chiapas, Mexico

Ayora-Diaz (2000). Imagining Authenticity in the Local Medicines of Chiapas, Mexico. Critique of Anthropology. 20(2): 173-190.
One important thing when considering other forms of healing not-biomedical such as the so-called “local medicines” is how people think about them, which symbolical and material efficacy it has for producers and users, and more importantly in this case what non-indigenous people directly related with indigenous people such as a NGO’s workers and other “foreigners” (such as tourists) may view them. In San Cristóbal de las Casas (Chiapas) there is an overlapping and intricate situation in which travelers and tourists embodying a “tourist gaze” (the idea of bracketing everyday life) come to be in contact with indigenous populations who are consumed as exotic and, in so doing, tropes of “community”, “solidarity” and “harmony with nature” are filtered through nostalgic views that divide “them” as “authentic” and “us” as “artificial”. So in this context authenticity plays a key role in how others see indigenous people (and how indigenous people portray themselves). Hybrid forms in local practices are considered politically incorrect, a break in their “cultural intimacy.” The author identifies two strategies that operate to protect the local sense of cultural intimacy: the establishment of the parameters that legitimize local ‘indigenous’ medicines, and the institutionalized confinement of religious medical practice to the museum and the past. The particular site of Chiapas is relevant to think on multiple forms of healing because there is a multiplicity of practices, practitioners and users beyond biomedicine, alternative and local medicines. Here is where the perception of authenticity plays a big role. Because users have to rank these heterogeneous forms of medicine according to their authenticity or lack of. In some places there is even certain tolerance from the biomedicine to local healers, for instance, in Comitán there are three Tojolabal-speaking healers working in the hospital (although “cosmopolitan doctors” –this is how the author refers to biomedical doctors– look down on them and call them as witches). There is also an Organization of Indigenous Healers (OIH) that tries to keep some power over their public image but it is in constant struggle with the “rational” legitimacy of the “cosmopolitan healers”. Still the problem is how local healers are portrayed through a romanticized and nostalgic view of indigenous life by the ladinos and mestizos who work in the OIH, and how these views imply a lot of assumptions (healers belong to a community, communities deal through consensus, ownership of land is communal and so after consensus healers can receive a piece of land for growing their medicinal plants, a true indigenous healers should not be interested in receiving money, and local healers cure with plants) and consequences to who may be helped by the organization. The tension here is again about authenticity, more precisely how authenticity is conceived. For the OIH a “real indigenous healer” has to represent his community and his community has to choose him, which is not always the case. Ayora-Diaz shows that local healers within the OIH tend to portray their processes of gaining healing knowledge as a learning one, whereas healers outside the organization refuse this image saying that “Local medicines are a gift from God; not something one can learn from anyone” (182). More importantly, the OIH also produces the Museum of Maya Medicine, which tries to capture the real Indianness and “authentic” “modern traditional” medicine; these are according to Ayora-Diaz “hyper-real healers within a simulacrum of community and tradition” (185). Here authenticity and purity of knowledge has become commoditized, and local people have to play this game with foreigners in order to keep their own forms of hybridization. One of the richness of this text is that engage with multiple forms of perceiving and acting upon the use of “cosmopolitan” and “local” medicines. Only at the end he mentions how tzeltal healer combine local and cosmopolitan medicines to heal sooner. And I think the author could have thought a little bit more about the local use of the wide palette of choices and this combination and hybridity. He only focuses on how biomedical and local healers negotiate ideas of authenticity for local healing knowledge but he could have added how their also negotiating ideas of authenticity for the “cosmopolitan” medicine.

Low (1987) The medicalization of healing cults in Latin America.

Setha Low (1987). The medicalization of healing cults in Latin America.
Low’s article “The medicaliation of healing cults” should have added a subtitle: “and the sacralization of biomedical doctors” “in Latin America” (and the medicalization of healing and demedicalization of medicine). This is precisely the dialectic and complex relation Low is trying to get at when considering the history/stories of two very influential doctors, Dr. Moreno Cañas in Costa Rica and Dr. Hernandez in Venezuela. On the one hand these two Doctors have things in common: upper class origin, went to Europe to study, return to work in the country, and help the poor giving health care for free. They engaged in social reforms, were seen as doctors-heroes due to their medical accomplishments, and after death allegedly returned in spiritual form to keep healing the one in need and so became the center of veneration and devotion as saints. Low says, “As the technological ‘magic’ of medical practice challenges religious healing’s claim to miraculous power, the number of lay, quasi-religious healing cults increases, sacralizing medical symbols by placing them within religious contexts” (137). Each of these doctors have a tragic death, Moreno Cañas was assassinated by a former patient and Dr Hernandez was hit by a car when was going to look for medicines for one of his patients. In both cases shortly after their death espiritismo cult began to spread (with spiritual mediums contacting the spirits of these doctors) and more people made promises to these doctors and ask for healing while their images were spread with the use of all sorts of representations. For Low three types of meaning were attached to these two doctors: 1) meanings derived from the folk Catholic form and the symbolism of the cult, 2) meanings derived from the specific symbolism of the doctors’ medical career (medical technology and symbols of modernity), and 3) meanings derived from the cultural medicalization in which professional doctors replaced folk healers, orthodox Catholic saints and virgins as the focus of cult veneration. Low concludes that the secularization of traditional symbols of religious healing is what is at stake when considering these two doctors and the ways they have influenced social changes and popular forms of healing. But I have to say that these doctors could also be seen as a subaltern appropriation of their powerful status as professional healers and members of the elites.

Afterthoughts: I think in this text and in the next one (Finkler 1994) a discussion on what is modernity is missing. And I think one should discuss this question because it underlines authors' ideas of "science" and "religion" and what is to be (or not to be) modern. The reader could find useful my post on Chakravarty's Habitations of Modernity.

Finkler (1994). Sacred Healing and Biomedicine compared

Kaja Finkler (1994) Sacred Healing and Biomedicine compared.
In this article the author contrasts two healing systems, the “Sacred Healing” system with the “Biomedical” system. And she does this comparison with the aim of highlighting both differences and similarities not only in the ways they diagnose and treat patients but also in how they engage with people’s experience of illness and healing. The main point Finkler made is that in the “sacred healing” what is at stake is the treatment techniques and the persona of the healer is less important (she is only a medium of a spirit) whereas in the biomedical encounter the persona (and the need of assuring patient’s compliance) is important because the treatment itself is more uncertain. The first distinction Finkler suggests between these two systems is that one is secular (biomedicine) and the other sacred (sacred healing) and one wonder if her use of “sacred” permit or preclude understanding of this phenomenon. It is “sacred” because it is health care system and it is associated with a religious movement and lacks what medicine has (professional system, made by trained professionals, and legitimated by the state). Furthermore, these two systems have an epistemological difference (although people use them in many cases at once judging their success by the their treatment effects).
One central point in this analysis is that sacred healers are usually women (and though not mentioned biomedical professionals are usually men) who have experienced sickness before, have been cured with spiritism and then became healers themselves with the help of spirit protectors. The gender issue is not considered in Finkler’s analysis but I think should be highlighted more. One of main difference that I’ve found compelling is how different both systems consider the role of the “patient”. In biomedicine, it has a passive role in relation with the doctor constant pursue of finding right diagnosis and treatments, needs to comply (“adhere” is the usual term) with the treatment and is seen in isolation as an individual (usually as at the physiological level). In “sacred healing”, in contrast, patients are active and engage in their own healing processes trying to re-organize themselves and their families lives although the diagnosis in itself is less relevant. Finkler even says that a certain “passive catharsis” occur when “the healer tells the patient what the patient is experiencing, eliminating the need for patients active verbalization of their discomfort” (182). The healing processes in both cases are dissimilar: in biomedicine the physician uses his clinical judgments to change the image of the body (for instance, change diet under the physician’s perception of patient’s obesity) whereas in the sacred medicine the engagement with the “community of sufferers” work as support and produce a change in the experience of the body in itself. And there is another difference in that doctors tried to situate the cause of the malady chronologically and in a specific site of the body, whereas the sacred healers is expected to know what the patient is having since she already suffered similar conditions and because the spirit helping her “knows everything” as usually tells patients. There are other differences too, the sacred healing is supposed to be a progressive reordering of person existence, a gradual transformation of his/her life and of their families (many men after the healing quit drinking, or abusing their wives and kids), in fact they are changing the social relation in which patients live emphasizing in the congregation as part of the cure. Whereas biomedicine, instead, treats individuals’ bodies but fails to transform peoples’ lives.
One problem that I see in this article is certain essentialization of both sides. It is clear the analytical distinction the author made between both systems, but we keep thinking what else is going on between the sacred healers and the doctors. Finkler mentioned that patients were seeking for cure in both systems but then she does not say anything or bring more lights to these more pluralistic use of the patients of both types of healing.

Chakravarty. Habitations of Modernity. Intro and Chapter 2

If modernity is a concept we must find some people or practices or concepts that are nonmodern. For 19th and early 20th century western philosophers and intellectuals there was a distinction between those modern and premodern. For Chakravarty “Western powers in their imperial mode was modernity as coeval with the idea of progress” and many “nationalists saw in it the promise of development” (xix). But can the description of something or some group as pre or non-modern be anything but the gesture of the powerful? How can we define those people (peasants and subaltern classes) who are contemporaries but at the same time challenging our “modern” separation between secular and sacred, feudal and capitalist, nonrational and rational? Some write about alternative or plural modernities, other about modernity at large. Modernity has lost its value but it is still necessary when dealing with issues of democracy and development, although we must exercise a spirit of vigilance with it. We are all traversed by the world capitalism but the pathologies of modernity itself should be considered in places such as India where issues of colonization and postcolonization produce a particular form of modernity. Chakravarty makes the distinction between modernity, democracy and civil life, India has become a greater democracy but not necessary liberal or nonviolent. Here the problem is how to characterize Indian modernity, many authors tried to call it using negative definitions borrowing European notions (not bourgeois, not capitalist, not liberal, or incomplete modernity, or incomplete bourgeois modernity), but for Chakravarty the most successful attempt to identify a positive way of describing the situation was Guja’s “dominance without [bourgeois] hegemony” although the without also suggested negative function. But the problem is that societies are different and sometimes it is hard to translate concepts or historical process from one to another, “Our use of negative labels may be read as an index of the problems of translation that we, academic intellectuals, encounter in describing Indian social acts through the filter of European-derived social sciences and political philosophies” (xxiii). For Ckakravarty write about modernity self-reflexively is not to equate being human with being political but the self-reflexivity about "the political" and the "modern" is itself something political. More over, (modern) notions of the political are secular but in the case of India for many groups political action implied a mix with religion. For the left there is no possibility to mix them because Indian secularism has to cultivate a rational outlook. But Indian historians (marxist, left-liberal) “have never been able to develop any framework capable of comprehending the phenomenon” (22) [the relation between politics and religion in India]. Religion can barely mean (for the historian such as Sarkar) a mean for a political end, but he cannot see that sometimes becomes and end en in itself. This is because Sarkar sees history as a continuous struggle between forces of reason and humanism and forces of emotion and faith. “The self-image of modern Indian secular scholarship, particularly the strands that flowed into Marxist social history writing, not only partakes of the social sciences’ view of the world as ‘disenchanted’, but even displays antipathy to anything that smacks of religious” (25). The problem for Ch. is that the (post)colonial hyper-rationalism lacks a language and “analytical categories to do justice to the real, everyday, and multiple connections that we have to what we, in becoming modern, have come to see as nonrational” (26). If religion and politics are irrevocable separated and opposed, then, modernity in India, according to secular historians, has seemed to be incomplete. But no one considered the possibility that India has its own modernity, and not a bad version of something that was an unmixed good, but the blame was in the colonialism, “colonialism stopped us from being fully modern” (28). But even the categories such as religion were/are not the same in Europe or India and so other categories used to understand Indian’s modernity. For Ch. the translations and the categories used are hybrid, impure and incomplete. And this process of colonization/modernization was at times violent and at times through persuasion, two forms of violence, one that institutionalizes and founds law and one that maintains law. But which is the relation of the intellectuals with those two kinds of violence. “If it is true that Enlightenment rationalism requires as its vehicle the modern state and its accompanying institutions-the instruments of governmentalitym in Foucault’s terms-and if this entails a certain kind of colonizing violence anyway, then one cannot uncritically welcome this violence and at the same time maintain a critique of European imperialism in India except on some kind of essentialistic and indigenist ground” (32). But the work is not to reject ideas of democracy, development or justice, the “task is to think of forms and philosophies of history that will contribute to struggles that aim to make the very process of achieving these outcomes as democratic as possible” (33) and we “write, ultimately, as part of a collective effort to help teach the oppressed of today how to be the democratic subject of tomorrow” (33) in a dialogue non-teleological recognizing that the history of subaltern social groups are fragmented and episodic. Fragmentary in a sense of fragments that challenge, not only the idea of wholeness, but the very idea of the fragment itself: “here, we conceptualize the fragmentary and the episodic as those which do not, and cannot, dream the whole called the state and must, therefore, be suggestive of knowledge forms that are not tied to the will that produces the sate” (35). “The subaltern is the ideal figure of the person who survives actively, even joyously, on the assumption that the statist instruments of domination will always belong to somebody else and never aspires to them” (36). “To critique post-Enlightenment rationalism, or even modernity, is not to fall into some kind of irrationalism” (37).

Benjamin. Theses on the Philosophy of History.

We have a certain relation to our image of happiness that is tied with the image of redemption. The past carries with it a temporal index by which it is referred to redemption. Nothing that has ever happened should be regarded as lost for history. Only a redeemed mankind receives the fullness of its past, and its past become citable in all its moments. “There is no document of civilization which is not at the same time a document of barbarism. And just as such a document is not free of barbarism, barbarism taints also the manner in which it was transmitted from one owner to another” (256), so a historical materialist has to dissociates himself from it as far as possible, he regards his task as to brush history against the grain. The “state of emergency” we live is not the exception but the rule. Angel of history (Klee painting) says “awaken the dead, and make whole what has been smashed”. Politicians’ stubborn faith in progress, and the negation of exploitation of labor and nature avoid the issue that oppressed class itself is the depository of historical knowledge. “This training made the working class forget both its hatred and its spirit of sacrifice, for both are nourished by the image of enslaved ancestors rather than that of liberated grandchildren” (260). Progress was considered as progress of mankind itself, infinite perfectibility of mankind, irresistible and automatic through a progression through a homogenous, empty time. But history is the subject of a structure whose site is not homogenous, empty time, but time filled by the presence of the now. Present is the “time of the now”, always open to Messianic time of redemption in the revolutionary chance in the struggle for the oppressed past. The present is change and the time in which the historian write history. Calendar as monuments of historical consciousness. Wreckage of modernity.

Foucault: What is Enlightenment?

Instead of looking at the present as a world era in which one belongs, or an event whose signs are perceived, or the beginning of an achievement, Kant sees the present as an “exit” or “way out”. He wants to understand the present as a difference. Enlightenment is the pass from maturity from immaturity, a pass that change the pre-existing relation associating will, authority and reason. And a man/woman has to free him/herself, Kant shows the obligation to know : “dare to know,” “have the courage, the audacity, to know”. Enlightenment is both a collective process and a personal act, men are elements and actors of a single process. Enlightenment is both a spiritual and institutional, ethical and political process through reason for reasoning’s sake. Reason must free in its public use and must be submissive in its private use (which is the opposite of the usual call of freedom of conscience). Reason must be subjected to particular ends in view. There is enlightenment when the universal, the free, and the public uses of reason are superimposed on one another. The public and free use of autonomous reason will be the best guarantee of obedience, on condition, however, that the political principle that must be obeyed itself be in conformity with universal reason. The self-reflection of Kant on his own work in this little article, is for Foucault a point of departure, the attitude of modernity. For Foucault modernity is an attitude rather than an epoch or a precise historical moment, it’s a way of thinking and feeling and a way of acting and behaving (tensions between the attitudes of modernity vs attitudes of “countermodernity”). For Boudalaire modernity is “heroize” the present and he says “we are each of us celebrating some funeral”. Modernity is not only a certain attitude/relationship with the present but also a relation with oneself, a production of himself. It is a simultaneous problematization of man’s relation to the present, man’s historical mode of being, and the constitution of the self as an autonomous subject. A permanent critique of ourselves but not confuse humanism vs Enlightenment and not fall in the “blackmail of Enlightenment” of being against or for Enlightenment (beyond outside-inside alternative): criticism consists of analyzing and reflecting upon limits. A genealogical/archeological inquiry of historical events, of particular areas, partial transformations and practical attitudes are perhaps more clear to analyze. Growth of capabilities and growth of autonomy/freedom are not separated from the intensification of power (state) relations (knowledge, power and ethics).

Kant: What is Enlightenment?

Kant, “Was ist Aufklarung,” in Foucault, The Politics of Truth

Enlightenment is self-enlightenment through reason and rational thinking. “Enlightenment is man’s release from his self-incurred tutelage” and “Tutelage is man’s inability to make use of his understanding without direction from another” (2007: 29) There is not need to think if other think or work for me, they would “guard” me, the problem is that one has to live out of any tutelage…But tutelage has become “almost his nature” for people who are not “accustomed to that kind of free motion”. If “freedom” comes, then enlightenment would come, but the point is a true reform in ways of thinking, especially the public use of one’s reason as a scholar instead of the private use of it. There is a relation between the scholar and his/her public in which he/she has an unlimited freedom to use his/her reason to speak in his/her own person.

Comments on Heidegger, Bachelard and Cassey.

Week 3
• Heidegger, Martin 1971 Poetry, Language, Thought. Albert Hofstadter, trans. New York: Harper. Chapter IV: Building Dwelling Thinking (pp. 143-159).

• Casey, Edward 1996 How to Get from Space to Place in a Fairly Short Stretch of Time: Phenomenological Prolegomena. In Steven Feld and Keith Basso, eds. Senses of Place. Santa Fe: School of American Research Press (pp. 13-52).

• Bachelard, Gaston 1994 [1958] The Poetics of Space. Maria Jolas, trans. Boston: Beacon Press. Chapter 1: The House. From Cellar to Garret. The Significance of the Hut (pp. 3-37).

Common reflections
The main point of the reading of this week, the phenomenological approach, is to put experience at the center of the analysis. In three texts the authors are debating with positivist and objectivist perspective of space that see it as absolute and empty. Space is not given or neutral, something that will be filled with culture. For these authors experience comes first, the being in the world, the dwelling is the primary source of knowledge. For the three authors place comes first and then space. For Heidegger, our experience of being mortals, our physical body in which we live comes first, its experience and perceptions and sensations then create the abstractions and racionalization of that experience as an objectified and out-there space. Not the other way around. It is precisely because we are dwellers, that we inhabit our houses and buildings, and the natural environment.
But what is to dwell? How buildings belong to dwelling? According to Heidegger the old English and High German word for building, buan, means to dwell, to remain, to stay in a place. To be a human being means to be on the earth as a mortal, it means to dwell and building can be seen as cultivating. One could argue that buildings and humans are constantly building themselves in a sense of inhabiting new forms and experiences (only if we take a poetic license to say that buildings are non-humans agent that have experience).
In Bachelard’s case his approach to how people experience inhabiting a (private) house takes a more psychoanalytical stand and a more poetic style. He wants to understand or better say evoke people’s experience when dwelling and inhabiting their own houses, although he seems to be talking about a mythical house. He brings into analysis a vertical approach to the experience of dwelling when he focuses in the attic and the cellar. He represents the cellar as the unconscious zone of the house, one that is always in the shadow, and the attic as the clear zone in which children play. There is a tension in his article in how places inside the space of the house reverberate in different ways and so construct different experience to the people inhabiting those places. Places through daydreaming (a sort of imagination) are also connected with memory, nostalgia and past experiences (especially early childhood experiences). But basically in Bachelard there is a distinction between the outside (public) and the house (private), between an exteriority and the feeling of intimacy and refuge.
Cassey, with his phenomological approach, is criticizing the modern view of space as absolute, epmty and infinite where places were only partitions of space. For Cassey, “Both sensations and spaces are themselves emplaced from the very first moment, and a very subsequent moment as well” (18), and he is very clear when he says, “we are not only in places but of them” (19).
I think what we can take from these readings is the necessity to place the body/subject as the perceiver, dweller, performer, actor that mediates between places and spaces. The lived body is the one that is emplaced and who experience space.

pensamiento conspirativo: el ataque a gaza fue por las elecciones proximas en israel

cada vez me convenzo mas que el ataque que hizo a israel a gaza fue causado por multiples motivos (cohetes del lado de gaza, israel bloqueando gaza, el odio, la bronca, etc) pero hubo una principal: las elecciones proximas del parlamento en israel. si uno lo piensa con ojos conspirativos es bien claro. israel aprovecho la ventana que tenian entre que obama habia ganado las elecciones pero todavia no estaba en el gobierno, que bush con su imagen destrozada estaba en ese limbo de un mes y pico y el 20 de enero que asumia obama. oh casualidad que el ataque termino 2 o 3 dias antes que obama asumiera asi ahora con nuevo gobierno todos podemos sentarnos a discutir.
yo creo que ninguno de los dos bandos de lideres politicos estan limpios, los dos tienen responsabilidades y sangre en sus manos, pero aca hay una cuestion de escala y proporciones muy distintas. las elecciones se vienen en poco tiempo y antes de la "guerra" ni el kadima ni el partido laborista podian si quiera acercarse al likud. ahora, en la ultima encuesta estan cerca. con lo cual podrian formar parte del gobierno del likud...

Good (1994)

Good, Byron. 1994. “Illness Representations in Medical Anthropology: A Reading in the Field” in Medicine, Rationality and Experience. An Anthropological Perspective. Cambridge: Cambridge University Press. Chapter 2.
In this chapter, Byron Good is trying to map the different approaches within medical anthropology in the last decades. Indeed, medical anthropology as an inheritor of colonial knowledge-power has been criticized from within and without over the types of cultural representations the discipline has created when portraying “the Other.” The anthropological analysis has shown that western biomedicine is one medical system among others in competition. It has also criticized the medical profession’s Enlightenment assertion that lack of knowledge and maladaptation are the causes of illness. One problem in medical anthropology as sub-discipline is that often anthropologists are at once critics and committed participants of the heterogeneous biomedical enterprise. One central question in this regard for Good, which I consider important too, is how we situate our analysis of cultural representations of illness, “encoded in popular or folk therapeutic traditions or in individual understandings and practices, in relation to the truth claims of biomedicine” (28). How we consider the authority of biomedical science is key to how we relate as anthropologists with those with whom we work. Following Kleinman’s definition, Good asks to what extent “disease” is different from “illness”? But I ask myself, using the distinction disease (biological), illness (personal) and sickness (social) aren’t we taking for granted the biomedical notions of body and causality that put first the biological causation and then the non-biological? The current debates concerning illness representations show four schools of thoughts: the empiricist tradition, the cognitive approach, the interpretative approach and the “critical” medical approach. The first approach was centered in understanding “cultural beliefs” in relation with illness, to modify “irrational (sick) behavior” and to decrease risk factors and obey medical treatments. But that approach was very much “mentalistic” in its emphasis in understanding what makes people ill but not focusing on the actual biological and physical problems associated with people’s illnesses. They just considered “culture” as “belief”. There was a profound separation between folk beliefs and biomedical scientific knowledge (knowledge would eventually correct inappropriate popular beliefs). The second approach was more centered in cognitive processes, the ethnotheories of illness and health. These studies tried to understand particular cultural segments of people’s lives in relation with ways of dealing/comprehending diagnosis, treatment and prognosis in specific cultural ways. But again, illness representations were understood in mentalistic terms detached from “embodied knowledge”, affect, and socio-historical forces that shape illness meanings. The third approach, the meaning-centered tradition considers the biomedical system as a cultural system. They put the relation between culture and illness as the core of the analysis but in a different way, they consider disease not as an entity but as an explanatory model. Explanatory in the way that disease is only understandable through interpretative activities, because “interpretations of the nature of an illness always bear the history of the discourse that shapes its interpretation, and are always contested in settings of local power relations” (53). So the embodied experience, how illness is experienced and represented within different cultural systems is what should be analyzed. The fourth approach, the “critical” applied medical anthropology, tries to grasp the political and economical forces that shape illness experience and influence biomedicine itself. So for instance, forms of suffering developed from class relations may be defined as illness, medicalized, “constructed as dehistoricized objects-in-themselves” (57). Therefore, hunger or poverty are often medicalized and individualized when the social causes of them are invisibilized and unproblematized. Thus central in this approach is a critical unmasking of the social fabric of these conditions and the dominant interests. But Good, coming from the third type of approach, is quick to show that each approach has its weakness. Biomedicine is not only mystification and masking, and using a “critical” name does not make any approach more crucial than others. But the biomedical enterprise is more complex, is a site of hope and despair, desire and hatred, it is a right and an obligation, so the human actions in relation to its power deserve a deep understanding, especially if we want to produce knowledge and actions that would democratize its access and reduce its abuses of power.
I agree with Good that medical anthropologists are in-between this field of great tensions, they analyze and participate at the same time in the phenomenon they try to understand. And it is not only this idea of dual-loyalty (to biomedicine and to patients/family/social circle) what is at the center of medical anthropology practice, but also the possibility of co-construction of the anthropological knowledge/practice. Besides the anecdotal discussion between clinical or critical medical anthropology, the real discussion is how our knowledge can be useful for the people that are suffering and which strategy we should develop in order to help them better.

Paul Farmer (2003).

Paul Farmer (2003). “Rethinking Health and Human Rights” in Pathologies of Power. Berkeley: University of California Press.
In this chapter Paul Farmer is trying to show how the same definition of human rights (HR) is open to contestation and discussion when considering it in a narrow or wide way. He takes the case of Russian prisoners in the attested prisons after the collapse of the USSR in which prisoners (under illegal long pre-trial detentions) are dying of TB in spite of having access to medication. Farmer shows that many social, economic and legal factors are interplaying to produce this sickly situation for the prisoners. Prisoners are first held in overcrowded jails, then in TB colonies, and are receiving old medication that does not do anything to the resistant type of TB they are experiencing. So for Farmer HR should be considered as economic and social rights, prisoners in Russia in TB colonies, having developed multidrug-resistant tuberculosis (MDRTB) are untreatable in such conditions. But many international HR organizations of wealthy donor nations using the logic of cost-effectiveness say they cannot give the right medication (not resistant) because they are too expensive for developing countries. But this argument of cost-effectiveness fails to consider that the majority of the drugs use in the treatment is old and so off-patented. Farmer shows that in poor countries such as Peru or Haiti MDRTB can indeed be cured. He also highlights that public health and access to medical care are social and economic rights. In other words, in order to understand violence inflicted over individuals we need to consider the deep-rooted structural violence that caused it and its relation with HR, according to Farmer, we need to develop a pragmatic solidarity. One problem I see, that Famer is very aware is the divergence between HR discourses and declarations at the international and national levels of jurisdization and the real experiences in which people live and the facts they face on everyday basis. If HR are not seen narrowly, if they are seen as economic and social rights the contradiction between HR discourse and real life is even more pronounced. So inequalities in health are difficult to reconcile because the same state that violates social, economic and civil rights creating wider inequalities is eager to cover these same violations. Many HR organizations are also very tied to economic, social and state powers. So the “pragmatic solidarity” is not only to denounce these violations but also to actually help the sufferers moving beyond the “blaming the victim” discourse. There is a need for moving beyond the analysis to find useful strategies for the poor and in need. Is to move from “who did what to whom, and when?” to “what is to be done?” Farmer suggests that in order to find strategies that would really work they need to put a new agenda of health and human rights, and make health and healing the symbolic core of the agenda. So in a way is to “medicalize the human rights” and Farmer considers this because he saw it can work, for instance with the Russian prisoners when the debate started to be a medical debate and not a legal or prison reform debate, the situation for the prisoners, the need to control the epidemic and to cure the prisoners started to change. And in doing so the sick and abused need to be listened and be part of the solutions. Finally I think one important issue is to re-consider the role of the state. States that legitimate growing inequalities and are urged to do more but are the same time are dispossessed (or portraying they are) of the means to alleviate these inequalities, basically the social and economic rights of the poor. I overall think that this chapter is showing the contradictions that HR organizations and researchers/activists have when trying to help to reduce the social inequalities. They are working within the frame of the state but trying to criticize and resolve some of the damage produced by the same state. So I agree with Farmer that we need to move beyond a narrow consideration of HR to a broader one in which economic and social rights of the poor are included. And a pragmatic strategy is needed if one wants not to reproduce what is not working and to find solutions that work for the people that need them. Sometimes considering "the poor" as a category seems over-simplifying but I do see his approach, with his loing experience in the field, as valuable and worth thinking.

Seanlon, Tomkins, Lynch, Scanlon (1998)

Seanlon, Tomkins, Lynch, Scanlon (1998). Street Children in Latin America.
The authors of this review try to look at the problematic children living in the streets face in Latin America. They follow the UNICEF’s (1986) definition of “street based” children and “home based” children meaning ones that live all the time in the street and ones that stay on the street during the day and return home at night. Other tried to find other definitions, but the UNICEF’s one was thought having Latin America in mind where up to 90% of the children have some sort of contact with the family (whereas in places like India this does not happen). The problematic of street children is enormous, some sources consider between 30 and 170 million street children in the world. Many intricate factors collide to “produce” street children, being the main one in my opinion the unequal distribution of wealth, the authors mention among others: land reform, population growth, drought, rural to urban migration, economic recession, unemployment, poverty, and violence. So these are economic, political, social and legal factors combined with lack of material and symbolical resources at the social and family levels (with histories of physical, emotional and psychological violence). Of course, these children have all kind of problems, they face physical, mental, sexual, and social violence, often leading to trauma, marginalization and assassination by death squads (most famously in Rio de Janeiro in the 1980s but still happening in all Latin America). So the problem needs a multidimensional approach, many actors such as Governmental agencies and Non-governmental organizations, and the street children themselves need to “intervene” and find creative ways beyond “rehabilitation” or victimization of the children. Some suggested solutions are to re-integrate children with their families, but this needs a reconsideration of the family as a system and ongoing support for many years to sustain the program. In Brazil the street children have started a movement (Movement of Street Children) that has pushed for new legislation and visibilization within Brazilian society. The authors show the supposedly contradiction that although Brazil has the more progressive legislation and a strong street children movement, violence, human rights abuses against children and impunity of the aggressors are still very high. But this leads me to think if violence and street children are not “functional” to the Brazilian society with its hyper-exclusion and hyper-concentration of wealth and because of this aggressors are “functional” too the overall system?

Armus (2003)

Diego Armus (2003). Disease in the Historiography of Modern Latin America.
In this introduction to the book, Diego Armus maps three (some times overlapping) currents in the historical analysis of diseases in modern Latin America: a new history of medicine, the history of public health, and the sociocultural history of disease. He highlights, and I agree with him, that these attempts to try to make historical sense of any given disease are a risky approach: “given the fact that human well-being and ill-being cannot be fully captured through the lens of a single disease” (16). But given that disease is an “elusive entity” that at the same time is biological, meaning-seeking, has a medical intellectual and institutional history, it’s a site for public policy, a feature of social role and individual identity, has cultural values, and a central component of doctor-patient relationship, given that disease is all this, there is also the recognition that “disease dos not exist until we have agreed that it does, by perceiving, naming, and responding to it” (1). Still one important point made by Armus is that diseases cannot be investigated outside their societal context. Armus wants to frame the articles of this book within three approaches (new history of medicine, the history of public health, and the sociocultural history of disease) having in mind the socio-political features of epidemics, the expansion of public health policies in relation with outer influential powers and state-formation processes, and finally, the cultural use of disease.
(I) In terms of the new history of medicine, Armus considers that now historians are less inclined to look at the biographies of the “big men” in the history of medicine, the “pioneers”, and instead they analyze how medicine work as an irregular process in tension with socio-cultural and political contexts in which doctors are immersed, and where certain doctors, institutions and treatments made their way to be more visible and successful while others. And this process of visibility/invisibility success/failure within medicine has to be analyzed in all its complexity to grasp the social and political dimensions of epidemics. Before the modern bacteriology the blame of epidemics was put on urban conditions that allowed the enemy (microorganisms) to grow and which forced intrusive and violent interventions. But according to Armus there is distinction between, on the one hand, more or less visible diseases and, on the other hand, countryside or urban settings, and these tensions influence the way public opinion and elites consciousness would consider specific diseases as epidemic or not (independently of the large or small impact on the population, for instance syphilis or leprosy were seen as epidemics whereas TB or malaria not having the latter more impact than the former). Armus reminds us that “the project of sanitizing the countryside or at least combating one of its endemic diseases ignited efforts to launch social policies and facilitated state expansion, the centralization of power, and nation building” (8).
(II) The history of public health has, however, another approach: it focuses on the political, economic and social dimensions of health institutions. Health problems faced by individuals and social groups and the political interventions to maintain or reinstate collective health are considered in this approach. A key factor here is the differential availability of public health resources at regional levels within Latin America and how different national projects have dissimilar impacts according to different regions. Another important issue is the interrelationship between external influential powers and nation-building processes. Although medical professionals were aware of what was going on in Europe and North America, they were in need to find specific solutions for specific problems often very different than of Europe or North America. Certain diseases such as Chagas were particular of Latin America but other such as malaria or yellow fever were politically constructed through an inter-national site of production/reception/transfer of expertise and practices in which international agencies such as Rockefeller Foundation played a big role in the region. These tensions between national and international medical groups were “complex, at times involving subordination, cooptation, alliance, pragmatism, conflict, or mutual adaptation” (10).
(III) The third approach, the sociocultural historical dimension of disease, considers the “socio-political or socio-demographic dimensions of a particular disease, medical professionalization processes, welfare and social control instruments and institutions, and the state’s role in building health infrastructure” (5). This considers the medical discourse of illness and the metaphorical use of disease. In terms of psychiatric medical power these studies focus on empirical information that highlights both the “instrumental and controlling aspects” of psychiatry and the “humanitarian and liberating” options in relation to mental health. Thus mental health is a space that goes beyond psychiatric power and incorporates public hygiene, mental institutions, utopian seek for collective moral development, and the history of nation-formation and state-formation.
The three approaches regard medicine as an “uncertain and contested terrain where the biomedical is shaped as much by human subjectivity as by objective facts” (6). And in doing so, they emphasize the importance of individual and collective “hygiene” as a “civilizing” project promoted (and often imposed) not only from above but also strongly supported from below. There is a tension in here between the medical enterprise and the ability and capacities of the sick to negotiate and even challenge the medical power. Therefore, three issues are important to highlight: 1) “public health interventions and medical practices can be resisted, accepted, or demanded according to local, cultural, social, political, and disease-specific contexts”; 2) these tensions should be considered in a short and long run to look at how medical practices are incorporated in specific instances but in the long process within people’s everyday life; and 3) focusing on the historical agency of the sick, not considering as a merely passive objects of medical practices and knowledge but as highly implicated in the processes in which they are the object of intervention.
I think that considering this article as an introduction of a book on the historiagraphy of epidemics in Latin America Armus makes a good work trying to synthesize the different approaches historians have developed when dealing with issues of illness and health but sometimes there is too much overlapping in the distinctions he is trying to make. If he is trying to make the point that diseases cannot be studied outside their specific societal context, and this context is surely contested and resisted at the same time maybe there is no other option than to have an overlapped analysis, but perhaps it would have been more useful to consider the specific role of say the nation-state or the medical professionalization in a more analytical way in order to shed more clear light to these issues.

todo lo veo a traves de los ojos de la inequidad social... sino vean esta nota de BBC

creo que casi todo de lo que nos pasa como humanos en estos tiempos esta causado por la incapacidad que tenemos en poder controlar la extrema pobreza y la extrema riqueza, una va de la mano con la otra, los cada vez mas excluidos de todo y los cada vez menos incluidos de nada, y los "super-millonarios" obsenos. el otro dia lei que en promedio los "CEOs" de las grandes multinacionales mundiales cobraron 10 millones de dolares solo en sueldos el 2008. multipliquen 10 millones por las 100 mas grandes multinacionales, eso da 1000 millones de dolares. 1000 millones el mundo uso para pagarle a 100 tipos. es una verdadera locura, lo mismo que haya gente con miles de millones de dolares. deberiamos inventar algun mecanismo para limitar el maximo y el minimo que una persona pudiera tener. y ademas es producto de la increible escalada especulativa que llevo a aumentar todo, si una casa aca en Canada o USA deberia valer 80.000 y se la termina vendiendo en medio millon, si un auto deberia valer 12.000 y se lo termina pagando 30.000, si todo iba siendo amasado y armado para mayor especulacion, algun dia esa bola iba a desinflarse. todo todo esta relacionado con la incapacidad para controlar la inequidad social...

BBC NEWS
Sick and uninsured in the US

BBC North America editor Justin Webb spares a thought for the 15% of Americans without health insurance, after his son needed hospital treatment - and the bills started arriving in the post.

Washington Children's Hospital could easily be part of the British National Health System. The staff are helpful enough, but brusque and overworked.

There is a lot of waiting. The lifts do not all function.

There are signs scribbled on paper and stuck on doors. And there are doctors trying, amid the hurly-burly, to do what they want to do - to treat patients, to ease suffering.

I was there, traumatised as any parent would be, with my eight-year-old son who had just been diagnosed with a chronic and life-changing illness: Type One diabetes.

It was just before Christmas.

A piece of paper on the bed informed us that we were entitled to select a present for Sam, free of charge, from a room in another part of the hospital.

I imagine the NHS has similar kindnesses at that time of year and I imagine the parents' tears and the doctors' efficiency are also much the same. But there the similarity ends.

Mounting bills

Late on Christmas Eve - with Sam out of hospital - I went to the chemist to pick up the kit: the syringes and emergency injections that will now be part of our life.

We are very well insured but I still paid more than $200 (£134) in so-called co-pays... amounts for each medicine that an individual is expected to fork out for, even when the recipient is a child.

For a person with no insurance or inadequate cover, amid the sadness and the stress of the diagnosis, this would have been a further blow.

To be followed by more.

Days after Christmas, as we were still struggling with our syringes and Sam was still wondering innocently if his disease might soon be cured, the real bills started arriving: $2,700 (£1,815)... then another $800 (£538). "Urology", it says starkly.

I assume that was a urine sample. It seems a bit pricey but there is no way of challenging this tsunami of reckoning.

The insurers wrote as well to say they had decided to pay the first bill. On the other - urology - they are so far silent.

Fifteen percent of Americans - including eight million children - have no insurance.

Diagnosed with diabetes, as Sam was, they would have been treated at Washington Children's Hospital - it insists proudly that it turns no-one away - but probably only after collapsing, because uninsured people tend not to go to the doctor to investigate symptoms.

And the parents would now be facing the kind of added burden that I find almost unimaginably awful: a sick child and a dependence on charity. Gifts from churches and drug companies, or a life of increasingly threatening letters, ending in bankruptcy.

Wealth divide

And so to my other Christmas destination, the Four Seasons Hotel in Miami, where we decided to go to cheer ourselves up and spend the money we had been saving for a later longer holiday.

"Carlos, I will not fly commercial! I just won't do it - it's too far."

This is not an argument. Carlos appears to know he has lost and he is looking indulgently at his gorgeously turned-out wife.

We are in a lift, my three children open-mouthed at this intrusion of wealth and glamour into our little world.

The deal was settled by the 11th floor. She would fly in his private jet.

I noticed that Carlos had a very expensive watch, but I doubt he would have to sell it to pay for her trip.

These folks - America's uber-rich - have certainly lost money in recent months but most of them are still pretty comfortably off, and there are many of them.

What a nation! With sick children chased for money while the rich bicker about their flying options!

What highs and lows there are in the America [President-elect Barack] Obama is inheriting!

Cautious changes

As it happens we could see from our hotel the glittering tropical sand bar of South Beach - the art deco part of Miami - which is, in an unequal nation, the most unequal place. It has the highest income disparity of any corner of the United States.

The enamel white yachts - some of them the size of cross channel ferries - are in sight of rooms, tiny rooms, literally under roads in some cases, where the poor live.

America is a place where money can be amassed and frittered away on private plane travel - a place where grieving parents face unpayable medical bills.

Obama will tax the plane owners more, and help the parents more, but within limits. Because he will not want to mess with the essential fact of American life, that the cruelty and the hedonism are a by-product of an extraordinary energy, freedom and sense of ambition.

Places like Miami - as meretricious as they seem - are also a magnet for the world's doctors, researchers, investors, thinkers and dreamers. Obama knows that.

He will change the US over the next four or eight years but he will not want to flatten its spirit.

A British friend who is a paediatrician tells me that the US is the place where the cure for type one diabetes will be found. And when it is found, millions will benefit.

And I would add that the researchers or the bosses of the drug company that funds the research, will never fly commercial again. Which is fine by me.

From Our Own Correspondent was broadcast on Saturday, 17 January, 2009 at 1130 GMT on BBC Radio 4. Please check the programme schedules for World Service transmission times.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/programmes/from_our_own_correspondent/7833290.stm

Published: 2009/01/17 12:05:43 GMT

© BBC MMIX

Las 10 crisis más olvidadas del mundo (La Voz de Galicia)

Un informe de Médicos Sin Fronteras recoge la lista de las crisis más olvidadas en las agendas mediáticas. De una nota de La Voz de Galicia.

Médicos Sin Fronteras es una organización internacional médico-humanitaria que aporta su ayuda a poblaciones en situación precaria y a víctimas de catástrofes de origen natural o humano, de conflictos armados, enfermedades olvidadas y epidemias, o exclusión. Este informe recoge la lista de las crisis humanitarias más desatendidas por la comunidad internacional en 2008.

MSF cuenta con 25.000 trabajadores en terreno, entre expatriados y personal contratado localmente. Cuenta con más de 350 proyectos de acción médica y humanitaria repartidos en unos 60 países, y 4 millones de socios y colaboradores en todo el mundo, de los cuales más de 400.000 en España.

1. SOMALIA: Empeora la catástrofe humanitaria

Aunque la ruina de las estructuras estatales hace que las estadísticas sean difíciles de confirmar, Somalia presenta algunos de los peores indicadores de salud del mundo: una de cada diez mujeres muere durante el parto y más de uno de cada cinco niños no llega a cumplir los cinco años.

La población somalí ya partía de una situación de lucha por la supervivencia, con poco o nulo acceso incluso a los servicios más básicos, cuando en 2008 quedó expuesta a uno de los peores episodios de violencia registrados en el país en más de diez años.

Como consecuencia, en especial en el centro y el sur del país, la situación humanitaria se deteriora cada vez más, sobre todo en lo relativo a los índices de desnutrición infantil. Al impacto de la guerra, además, han venido a unirse los desorbitados precios de los alimentos y una prolongada sequía.

Cientos de miles de personas viven hoy en zona de conflicto. El recrudecimiento de los combates en una de las zonas más pobladas de Mogadiscio provocó un gran número de heridos civiles así como el desplazamiento de miles de personas.

A ello hay que sumar el flagrante incremento de ataques selectivos (incluyendo asesinatos y secuestros) contra trabajadores humanitarios, convirtiendo Somalia, país con un sinfín de de necesidades humanitarias, en un lugar donde resulta práctica-mente imposible proporcionar asistencia.

2. MYANMAR: Críticas necesidades sanitarias siguen desatendidas

El 2 de mayo del 2008, el ciclón Nargis dejó a su paso por Myanmar una estela de devastación, haciendo estragos en el Delta del Irrawaddy, donde murieron o desaparecieron unas 130.000 personas, y situando de nuevo al país asiático bajo el foco de la atención internacional.

La catástrofe asestó un duro golpe a una población olvidada por el resto del mundo, sometida al gobierno de un régimen militar desde 1962 y a un conflicto de baja intensidad en algunas zonas del país.

Mientras tanto, necesidades de salud crónicas y urgentes siguen desatendidas. Ni el Gobierno ni la comunidad internacional invierten en este sector: en 2007, el gasto gubernamental en el sistema de salud fue de 50 céntimos de euro por persona, un 0,3% del producto nacional bruto.

En cuanto a la ayuda humanitaria internacional, apenas superó los 2 euros por persona, la más baja del mundo. La ceguera selectiva a las necesidades en todo el país, incluyendo zonas especialmente afectadas por el VIH/Sida, la tuberculosis y la malaria, sigue costando la vida a miles de personas cada año y requiere más atención.

La población no puede esperar a ser golpeada por otro desastre natural para que sus inmensas necesidades sanitarias sean reconocidas. Tanto el Gobierno de Myanmar como la comunidad internacional deben actuar con urgencia con el fin de impedir miles de muertes innecesarias más.

3. ZIMBABUE: Crisis sanitaria, violencia y derrumbe económico

Los primeros meses del 2008 estuvieron marcados por el colapso económico y la violencia política. Aunque el país atraviesa una crisis desde hace años, la situación se deterioró hasta alcanzar unos niveles alarmantes, con una inflación del 231.000.000 %, escasez de artículos de primera necesidad, represión de partidarios de la oposición y restricciones adicionales contra las organizaciones humanitarias al aproximarse las reñidas elecciones de junio.

La crisis fue especialmente perturbadora para los dos millones de personas con VIH/Sida que se estima pueda haber en el país. Según Naciones Unidas, debido a la pandemia, la esperanza de vida en Zimbabue ha caído en picado hasta los 34 años.

Como resultado de la crisis, muchas personas sometidas a tratamiento tuvieron que reducir la cantidad y calidad de su alimentación justo cuando más la necesitaban, no pudieron costearse los billetes de autobús para acudir a las clínicas, o simplemente tenían miedo de salir de casa.

Durante todo el año, cifras alarmantes de personas siguieron huyendo del país, entre ellos el muy necesario personal sanitario, lo que contribuyó a incrementar la presión sobre un sistema de salud ya al límite.

4. REPÚBLICA DEMOCRÁTICA DEL CONGO: Civiles atrapados en una guerra que hace estragos

Desde septiembre del 2007, nuevos enfrentamientos en Kivu Norte han provocado desplazamientos masivos en la región. El acuerdo de alto el fuego de enero de 2008 no fue respetado y hacia finales de agosto estallaron de nuevo combates a gran escala entre varios grupos rebeldes y las fuerzas armadas congoleñas (FARDC), a pesar de la presencia de la fuerza de paz de la ONU más grande del mundo, la MONUC.

Miles de personas huyeron en todas las direcciones, en una desesperada búsqueda de seguridad. Los desplazados, muchos de los cuales se han visto obligados a huir en múltiples ocasiones, tienen poco o ningún acceso a la atención sanitaria, alimentos, agua o refugio.

Encuentran cobijo en campos o con familias de acogida o se esconden en el bosque, bajo la amenaza de ataques por parte de todos los grupos armados. Pocas son las agencias humanitarias que lleven a cabo programas de ayuda con una presencia continuada fuera de Goma, la capital provincial.

5. DESNUTRICIÓN: Millones de niños sin tratamiento a pesar de los avances

Los disturbios registrados a principios de 2008 pusieron de manifiesto que el impacto del aumento de los precios de los alimentos era igual de grave en países tan apartados entre sí como Haití, Bangladesh o Costa de Marfil.

Menos visible, aunque más mortífera y omnipresente, fue la constante crisis de desnutrición infantil. Aunque para combatir el hambre es necesario tener acceso a alimentos en cantidades suficientes, para frenar la desnutrición también hay que garantizar alimentos de calidad nutricional: los niños, en su primera infancia, necesitan para su supervivencia y desarrollo alimentos ricos en nutrientes, vitaminas y minerales.

Las cifras son impactantes. La Organización Mundial de la Salud (OMS) estima que hay 178 millones de niños desnutridos en el mundo. Cada año, la desnutrición es responsable de entre 3,5 y 5 millones de muertes de niños menores de cinco años. Se-gún UNICEF, la situación está empeorando en 16 países.

Lejos de las emergencias humanitarias de alto perfil que cubren los medios, se ven obligados a una lucha por la supervivencia en la que sólo cuentan con dietas de poco más que copos de maíz o arroz: el equivalente a vivir de agua y pan.

6. ETIOPÍA: Necesidad crítica de asistencia en Ogadén

La violencia continuada y las duras condiciones meteorológicas han convertido el día a día en una lucha constante para la población de Ogadén, también conocida como la Región Somalí de Etiopía.

Atrapada entre los grupos rebeldes y las fuerzas del Gobierno, la población mayoritariamente nómada se ha ido quedando más y más aislada de los servicios básicos y de la asistencia humanitaria.

Debido a los peligros y restricciones asociadas con la importación de productos a la región, la disponibilidad de alimentos y otros artículos esenciales en los mercados locales ha disminuido drásticamente y las subidas de precios han hecho que los alimentos básicos sean inaccesibles.

Al mismo tiempo, las restricciones de movimientos en algunas zonas han incrementado la vulnerabilidad de los nómadas, que no pueden ir en busca de agua o alimentos para su ganado.

La población ha visto cómo la sequía y el conflicto destruían sus cosechas, sus reservas de alimentos, sus pastos y su ganado. Algunos además han sido víctimas de la violencia.

7. PAKISTÁN: Los combates se intesifican en el noroeste

Los enfrentamientos entre las fuerzas del gno y militantes antigubernamentales en la Provincia de la Frontera Noroeste y las Árearibales bajo Administración Federal se han intensificado en 2008. Los ataques aéreos del Ejército estadounidense en la zona también han incrementado la inseguridad.

En agosto, miles de paquistaníes se vieron obligados a abandonar sus hogares y desplazarse dentro del país o huir al vecino Afganistán. Al mismo tiempo, el Ejército paquistaní empezó a expulsar a refugiados afganos, concretamente en el distrito de Bajaur Agency, por supuestas conexiones con grupos militantes.

Durante el transcurso del año, cientos de personas en Bajaur Agency y en las regiones de Swat y Mohmand resultaron muertas o heridas debido a atentados suicidas, ataques aéreos y disparos, con miles más teniendo que abandonar sus hogares en repetidas ocasiones.

En octubre, un estallido de violencia causó el desplazamiento masivo de cientos de miles de personas a regiones vecinas en el transcurso de apenas unos pocos días. Huyendo de ataques aéreos y bombardeos, muchos encontraron refugio en casas particulares, mezquitas, escuelas y campos improvisados.

8. SUDÁN: Continúan la violencia y el sufrimiento

Sudán siguió viéndose azotado por dos graves emergencias humanitarias en 2008: la crisis en Darfur y las consecuencias de décadas de guerra civil en el sur del país. Pero a pesar de los esfuerzos internacionales después de cinco años de crisis, cientos de miles de personas siguen sin acceso a la ayuda.

Varios miles más corren el riesgo de perder la asistencia que reciben debido a inestables líneas de frente, alianzas cambiantes entre las diferentes facciones armadas, ataques selectivos contra trabajadores humanitarios y unas cada vez mayores restricciones para la provisión de asistencia de emergencia.

La mejora de los indicadores de salud pública oculta el triste hecho que, para la mayoría de la población en Darfur, la situación de seguridad se ha deteriorado significativamente en 2008. Son muchas las personas que buscan refugio en los grandes campos de desplazados, pero el hecho de que estos acojan a miles de personas no significa que sean seguros.

En medio de todo ello, la falta de ayuda humanitaria se hizo evidente: algunos donantes importantes desviaron sus fondos a otras crisis y la presencia de agencias humanitarias se redujo por falta de recursos. En el horizonte están las elecciones de este año y, a falta de la publicación del censo, existe el riesgo de que se retrasen y que la violencia de nuevo vuelva a estallar en la región.

9. IRAK: Los civiles necesitan asistencia urgente

Uno de los mayores desafíos a los que se enfrenta hoy la acción humanitaria es poder llegar a los civiles atrapados por los conflictos armados. Irak, donde MSF ha intentado afianzar su trabajo desde que se produjo la invasión encabezada por Estados Unidos en 2003, constituye el mejor ejemplo de ello.

Varios actores militares y políticos han intentado utilizar y abusar de la acción humanitaria con fines políticos, convirtiendo a las organizaciones humanitarias en el blanco de ataques violentos, y socavando su capacidad para responder a las críticas necesidades de la población civil.

La guerra ha provocado el desplazamiento de cuatro millones de personas, la mitad de ellas atrapadas dentro del país, según ACNUR y el Consejo Noruego para los Refugiados (NRC). Sin embargo, a pesar de estos cambios, la situación es incierta y muchas personas todavía viven bajo la amenaza de la violencia.

Los esfuerzos llegan a una muy pequeña parte de las personas que lo necesitan. La complejidad de las heridas tratadas y la alta prevalencia de multitud de infecciones bacterianas resistentes a los medicamentos dan una cierta idea de la gravedad de la crisis humanitaria en el país.

10. CO-INFECCIÓN VIH/TB

Cada año, la tuberculosis (TB) acaba con la vida de aproximadamente 1,7 millones de personas, y 9 millones desarrollan la enfermedad activa. La TB va en aumento en países con altas tasas de Sida, particularmente en el sur de África: se estima que en los últimos quince años los casos de TB se han triplicado en países con una alta prevalencia del VIH.

De hecho, la tuberculosis es una de las principales causas de muerte entre las personas seropositivas, que tienen 50 veces más posibilidades de desarrollarla. Se considera que cerca de un tercio de los 33 millones de enfermos de Sida del todo el mundo contraen la TB latente. Y sin embargo, en 2006 menos de un 1% de las personas seropositivas se sometieron a pruebas de diagnóstico de la tuberculosis.

Aunque el tratamiento del Sida ha atraído una notable atención mundial, la mayoría de personas coinfectadas por VIH y TB han pasado desapercibidas porque no existen herramientas de diagnóstico sensibles, y el tratamiento de pacientes coinfectados es complicado. Mientras los programas siguen centrados en enfermedades individuales, los pacientes puede que padezcan ambas afecciones o incluso algunas más.

Los financiadores y los gobiernos nacionales deben invertir en nuevos diagnósticos y tratamientos que realmente empiecen a hacer frente a esta creciente amenaza sanitaria.
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Manderson (1998)

Manderson, Leonore. 1998. Applying medical anthropology in the control of infectious disease. Tropical Medicine and International Health 3(12): 1020-27.

Anthropological interest in issues on health, illness, death and dying has been part of the main core of the discipline since its early colonial conceptions. But, according to Manderson, issues related with infectious disease control/intervention have been only recently analyzed. So now some focus has moved to analyzing particular illnesses with the specific questions that each illness would bring. Thus understanding not only how human behaviour and social structure work in the spread of infectious diseases, but also how interventions for preventing and treating those diseases could be implemented too. There is a tension between considering on the one hand biomedical knowledge (linked with science, right and truth) and on the other hand laypeople beliefs (indigenous, wrong, magic and myth). Another source of tensions is the field in which medical anthropologists work, many are employed in multinational organisms that tend to de-contextualize the causes that produce illness while they privilege their knowledge over the subjects awareness of their own situation. The problem for medical anthropologists is that they are in middle and they have a “considerable unease in documenting behaviour and beliefs assumed to contribute to disease and ill health, in isolation from the social, economic and politic contexts” (1998: 1021). For Manderson anthropologists should have a “pragmatic position” with a dedication to ease suffering but more as cultural broker (see Scheper-Hughes [1990] critique) helping the access of populations to “effective interventions” (antibiotics, multidrug therapy, early diagnosis and appropriate treatment). She considers that although “local remedies” (she does not mention “medical systems”) could be effective in preventing infections or reducing suffering they are not as effective as biomedicine. And she goes saying that as Wall (1995) argues, “shamans’ songs cannot treat obstructed labour; neither, in the context of this paper, do they prevent pneumonia, malaria or dengue fever” (1998: 1021). The problem I see here is how Manderson defines “context”. She said before that political, economic and social contexts are important but when dealing with infectious diseases they do not count and only biomedicine. She proposes a “rapid anthropological assessment” as a tool to develop when anthropologists work as consultants. Usually anthropologists working for big organizations are under contractual and logistic constraints and because of this they need to rapidly assess the cultural and biological needs people have in relation with ill conditions. One key issue with this approach is to be aware of not over-simplifying people’s behaviour and beliefs due to the loss of contextual information. Another important thing to consider is the need to have an early diagnosis and treatment of diseases such as TB or malaria, and for doing that Manderson proposes to: recognize how people manage to diagnosis illness and/or slight disorders from life threatening disease; and the conditions that preclude or permit the use of biomedical services (if they have access to) and compliance to treatment. The aim for Manderson is to diagnose and treat people in early stages so she presents the case of how laypeople understand cough in relation to pneumonia, and she observes that folk categories may delay biomedical treatment. For her “circumstantial factors” such as “cash” and lack of transportation may complicate and delay the seek for care and would explain why “women with sick children present to clinics relatively late” (1998: 1022). The key action to take is to prevent infection disease and change (ill-oriented) people’s behaviour. Of course, these interventions require financial and infrastructure investment in order to change the social and environmental conditioning of illness, the social conditions of poverty and inequality, and the access to remedies and biomedical services. The problem for Manderson is how people adhere and observe treatments, but when people do not adhere or observe them is not only because of misunderstanding or structural barriers, it is more complex.

Scheper-Hughes (1990)

Nancy Scheper-Hughes. (1990) Three Propositions for a Critically Applied Medical Anthropology. Soc Sci Med 30(2): 189-197.

According to NSH Clinical Medical Anthropology (CMA) is a medical anthropology applied to the needs of the clinic, which considers the materialistic and positivistic premises of biomedicine, and in so doing it take them (almost) unquestionable and for granted. Medical anthropologists play –and self-concede- the role that the hegemonic biomedicine consent to them, they are mediators, translators, “cultural-brokers” between professionals and laypeople. They try to ameliorate doctor-patient relationships (from the biomedical viewpoint). That is, they aim to sort out in which ways laypeople could be “integrated” and “acculturated”, but they do not consider the relation of the patient with her social circle because it risk to criticize the hierarchical and disproportional economic and power relations that this encounter/clash produce. Medical anthropologists are usually not situated on the side of the “disreputable, stigmatized and marginalized patients’ rights and self-help groups or other critical sub-cultures of the sick, excluded and confined” (1990: 192).
Against this form of looking at issues of health/illness there is another position, which considers that we should practice not only a mere medical anthropology (with the subjacent premises, problems and interests of biomedicine as yours) but an anthropology of affliction and human suffering that has not other choice than moving beyond the western biomedical horizon. Because of this, NSH emphasizes in the need to contextualize its impact in all societies in this even more “globalized” (westernized) world, and particularly the conflicting relations with other medical systems subordinated and/or parallels the hegemonic. The Critical Medical Applied Anthropology (CMAA) complexify health/illness issues broadening the gaze and analysis with historical perspective and with the reflection on economic, political and ideological processes.
But what is wrong with situating on biomedicine' side? Beyond the positive aspects of biomedicine should be clear that it has created many obstacles, mainly it has medicalized and individualized (privatized) the social relations that shape afflictions/sufferings, instead of collectivize and politicize them. For NSH in order to create a critical medical anthropology an epistemic brake with biomedicine should be produced, and she proposes three possible ways to do so: (1) de-medicalization (reduce the parameters of medical efficacy to what is really working), (2) non-ortodox ethnomedicine (heterodox and alternatives therapies that have proven to work in many cases), and (3) radicalization of the medical practice and knowlege (in line with the Anti-Psychiatry movement, rebel the institutions of social control: asylum, hospital, Psychiatric and transform them in places of revolution and social critique, and linking the marginalization, suffering, and exclusion that happen within these institutions with what is ocurring within the family, community and society).

Singer (1990)

Merril Singer. (1990) Reinventing Medical Anthropology Toward a Critical Realignment. Soc Sci Med 30(2): 1979-87.

At the beginning of the 1990s there was a big discussion in regards the role and function of the anthropology study of health and illness issues. One of these voices was Singer, who in this article proposed a realignment of the medical anthropology moving beyond a particular narrow understanding of social relations, the lack of attention to political and economical forces in the clinical setting, an individualistic approach to social relations, and a tendency to medicalizing human behavior. The normal focus of clinical medical anthropology for Singer is the patient-doctor relationship, hence this understanding of the relation avoid macro-contextual analysis of causalities that often are out of sight but nonetheless powerfully shaping those interactions. Another “classic” focus of clinical medical anthropology, the meaning-centered approach (in line with what Geertz was doing with other forms of anthropological knowledge) has also a limit in its conceptualization due to patients and physicians are not only living in different semantic worlds but also producing and consuming these different webs of significance and mystification in very unlike ways. There is an “ecological orientation” in medical anthropology that tends to see how patients should fit their social environment using an approach that individualize and “blame the victim” instead of looking at macro-political economical factors. This happens because medical anthropology has also been medicalized in its aid to the hegemonization, stratification and social control of current biomedicine. One thing that Singer is trying to emphasize is the micro-levels are simultaneously influencing macro-contexts and vice versa macro-contexts manifest at the micro-social levels considering them not as autonomous, self-contained, traditional, community, local or behavior patterns but as the interplay of both levels at once. Secondly, the world system with its influence in the biomedical system and connections between medicine and capitalism (capitalist medicine) should not be overlooked. Thirdly, diseases are both organically/physically/biologically originated but also socially/collectively produced (what Singer calls the relation between micro and macro-parasitism). Fourthly, the social context of biomedicine should be considered having in mind that bio-medicine is neither The System nor just one among many other medical systems: biomedicine is a capitalist medicine in these late forms of capitalism. This leads to the fifth point that is that biomedicine functions as a dominant model that subordinates other forms of medicine, so there are different levels of health care systems, and alternatives forms sometimes proliferate because they are a sign of resistance to the monopolization of biomedical and other forms of domination. Sixthly, the sufferer experience should be the center of our analysis, “sufferer experience is constructed and reconstructed in the action arena between socially constituted categories of meaning and the political-economic forces that shape the contexts of daily life” (Singer 1990: 184). Indeed, focusing on the sufferer would help to have a better understanding of how sufferers might individually and collectively confront, challenge and displace some forms of medical domination. The ultimate goal for Singer is not to understand how biomedicine is working and producing certain forms of power and subjectivity but to change medicine. And to do so we must ask with Singer: “whose interests our work further; who is empowered by our efforts; on whose standards does our work confer social legitimacy; what is the source of our ideas and taken-for-granted understandings of social reality; and, what is the structure of social relations that our endeavors reinforce or reproduce?” (1990: 185).
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Massey (2005)

Massey, Doreen 2005 For Space. London: Sage. Chapter 12: The Elusiveness of Place, Chapter 13: Throwntogetherness: The Politics of the Event of Place, and Chapter 14: There are No Rules of Place and Space (pp. 130-176).

Places as integration of space and time, as spatio-temporal events always moving, open, in process of becoming within a sense of interconnection and transience. Natural places also constantly change. Everything everywhere changes but according to specific forms of “here”. However why we cannot grasp this constant change and tend to think in static and fix way “nature”, “culture” and “society”? It seems that Massey is thinking on the spectrum that goes from geological and planet scale to micro-movements of tiny stones, from the constructors of pyramids five thousand ago to “our time” everything is in constant fluidity considering at the same time “space” (“Geography”), “time” (“History”), “culture” (“Social Anthropology”), and “nature” (“Science”). And this encounter, this “here” and “now” is what “we” have. What is important of the place for Massey is the throwntogetherness, the negotiation of here-and-now, the steady fusion/fission of elements, a “coming together of trajectories” (141). Bodies (human, of water), places (mountains), and identities (political) are collectively shaped through practices, which forms relations, and “it is on those practices and relations that politics must be focused” (148) but more importantly for Massey space itself is the site of interconnection and social formations in a constant becoming of trajectories, histories and stories, indeed it is a constellation of trajectories both “natural” and “cultural” that are part of a continuous negotiation. And I like the definition of politics by Mouffe (quoted by Massey) that considers “the always-to-be-achieved construction of a bounded yet heterogeneous, unstable and necessary antagonistic ‘we’” (154). She takes the example of the City of London with its overpaid financial workers and how they impact in the high cost of housing and living: the inequalities of the system in which few are overpaid and everyone has to suffer the costs. More specifically, the last concentration of capital and wealth in the financial economy and the refusal to consider any forms of redistribution of the (national?) wealth with the allegedly threat that if not finance would go to Frankfurt instead of London or other regions within England would take a bigger portion of the tax revenue from London...But London/England is also part of the larger constellation of trajectories of the unequal relation north/south, first/third world in a Faletto-Cardoso vein. And these constellations are not stable or coherent both spatial and temporal because they are constantly changing and struggling. The problem of the social construction of place though is a political one, is the political position-taking within the spatialized social practices and social relations of power. Massey suggests that we are responsible toward place but yet there are no spatial rules from which guide our politics.

Malkki (1997)

Malkki, Liisa, 1997 National Geographic: The Rooting of Peoples and the Territorialization of National Identity among Scholars and Refuges. In Akhil Gupta and James Ferguson, eds. Culture, Power, Place: Explorations in Critical Anthropology. Durham: Duke University Press (pp. 52-74).

The deconstruction of a certain form of seeing and thinking in relation to entities such as nations and national borders, which implies ”sedenterian metaphysics”, these tensions between sedentarism and displacement, “rooted” and “uprooted” identities, “national” and “supranational” is what is at stake in Malkki’s article. She understands identity as “always mobile and processual, partly self-construction, partly categorization by others, partly condition, a status, a label, a weapon, a shield, a fund of memories, and so on” (71). There is a need to consider in new ways ideas of territory, belonging, roots, culture, diaspora, displacement and identity. But are these new questions? Like Malkki I also agree that people have always moved because of desire or violence. The first question I need to pose following Malkki’s believe in particular theoretical shifts that “give these phenomena greater analytical visibility” (53) in social sciences is why now (late 1990s) are these phenomena more visible? Because of the allegedly lack of grand narrative (Nation, Class, Rationality, Truth, etc.) that supposedly legitimate the order of things in the world? If people were constantly moving and societies were extending their influences beyond and beneath the national borders why the rooting/uprooting of people and the de/re-territorialization of (trans)national identities were not at stake before? It is true that identity has been intensely territorialized not only for the ones shown by Malkki, the displaced and the “refugees”, but also by people living the “homeland” too. Identities formations in the late capitalism have been centered in a dis-continuum that goes from the “rooted” “homeland” to the displaced/”uprooted” “refugees” in the “exile”. And these images are based in certain tropos taken by the botanical arsenal of images such as (national) “soil”, (home) “land”, “roots”, “trees”, “seeds”, and “origins.” And like real trees, roots have to be enrooted in one specific place/space/soil; they cannot be in different and discontinuous places at the same time (unless we re-consider what we mean by identity and belonging in different ways). This idea of “national geographic maps” is precisely what Gupta and Ferguson are criticizing in the other article we saw this week: the supposition that 1 place = 1 space = 1 culture as a monolithic entity with no ambiguities or incoherence. This is what Malkki, following Deleuze and Guattari, called a “sedentarist metaphysics” that produce a moral order that fixed and incarcerated “native” people in the “rooted” lands or pathologyzed “uprooted” “expatriates” in their “exile”.

Gupta and Ferguson (1992)

Gupta, Akhil and James Ferguson 1992 Behind “Culture”: Space, Identity, and the Politics of Difference. Cultural Anthropology 7(1):6-23.

The world has always already been spatially connected. What characterize the anthropological endeavor are certain forms of representation of culture, but when dealing with representing space it seems that within social sciences we need to use images of split, break, and displace. And this need comes from the unproblematic assumptions that cultural artifacts such as nations or countries and space are transparent and interchangeable monolithic entities that are “naturally” fitting. Of course, there is always a tension and something exceed the effort to map the territory, all type of mental and material mapping techniques have themselves a limitation to their ability to represent space. But the problem according to G&F (1992: 7) is that “space itself becomes a kind of neutral grid on which cultural difference, historical memory, and societal organization are inscribed.” And this non-neutral neutrality produces a generative principle in the social sciences while invisbilize space from social analysis. Space is everywhere in society but nowhere in the social analysis. But I think this idea of discrete cultures-spaces-places was highly influenced by the nation-states rhetoric of the last 200 years of one nation = one state = one culure, and this is not enough considered by G&F. Question: what we could not see in social sciences, the generative force of space within and beyond “culture”, only became visible after the fall of the bi-polar world and the meta-narratives from which they were sustaining their dominance? Why only after the 1990s social scientists began to consider space in itself as a problem and object of thinking? Or was it that according to G&F the new forms of flexible accumulation have de- and re-territorialized space breaking older notions of community, identity and difference? How are the processes that are territorializing in very different ways our identities?
But the problem is that spaces are experienced and constructed in very different ways and this make impossible the supposedly transparence of place=space=culture, spaces, places and cultures are not given. More over, places are made under a diverse range of ideologies (nation-state being only one among others) that politically imagine them as spaces. The problem is to recognize the hierarchical power relations and interconnection of spaces-places and criticize the natural disconnection. Difference come through interconnection, interconnected space always already existed. Localities or communities are not natural they come to be from the interconnected space, but “notions of locality or community refer both to a demarcated physical space and to clusters of interaction, we can see that the identity of a place emerges by the intersection of its specific involvement in a system of hierarchically organized spaces with its cultural construction as a community or locality” (1992: 8).
So another question is how to represent the social spaces and the cultural-political differences of the “other” and the “us” in the anthropological encounter without conceiving both as “pre-existing ontological entity”, more importantly how is constructed this difference when the world is becoming more and more culturally, economically, socially, and politically interconnected? The process of the production of cultural difference occurs in unbroken, linked space, traversed by economic and political relations of inequality. The problem is not how anthropology represent the others but the extra-textual roots of the problem of the politics of otherness/sameness. Because processes of de/re-territorialization have undermined the fixity of "ourselves" and "others" so we also have to reconsider what we mean by our and other cultures.

virtual space and togetherness

we have two vignettes which portray how virtual/real spaces and here/now togetherness are being experienced in our time-space.
por ejemplo, tenemos las fotos de la cena de navidad con nuestros amigos tomando vino y comiendo una picada mientras venia la cena, y con ME que estaba en Quebec acompaniandonos por skype, ella estaba igual de presente con nosotros. (ver fotos).
and then we have this ad made by oreo coockies, in which a father and son are sharing their most favorite ritual, in a interconnected (virtual? affective? real?) space-time.
ambos ejemplos muestran lo que Massey (2005) llama the "coming together of trajectories”