martes, febrero 10, 2009

Briggs (2003) Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare.

Briggs, Charles. 2003. Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare. Berkeley: University of Berkeley Press.

This book is about social imaginary and social inequality. It is also about the modern projects of creating different kinds of citizens. For Briggs, the creation of denigrating images, its circulation and consumption shapes public perceptions and the creation of public policy. He situates these tensions between the social production of sanitary citizens (capable of understanding modern medicine and providing self-care) and unsanitary subjects (inept to self-care and/or understand medicine) such as the Warao indigenous people in Venezuela as the struggle for appropriating or denying basic social and political rights. In this line he is very close to Paul Farmer’s approach. Briggs considers that the associations between Cholera and poverty and cultural difference facilitate the legitimacy of social inequality in each place. Thus, to think about disease and inequality without blaming the others creates the need for practicing health and social sciences on the “basis of a shared sense of responsibility and justice” (xviii).

Like Chagas, Cholera is considered a “disease of poverty”, in which certain forms of orientalism produce associations with pre-modernity and superstitions, although many epidemiologists think it is indeed a modern disease. For instance, if you one considers that national-states in Latin America have been attacked by, and shaped their practices because of, international monetary organizations such as IMF or World Bank in the 1980s and 1990s (and before in the 1970s helping with money dictatorships) and the involvement of US and other rich nations in Latin America supporting military governments, one could conclude that these other forces have “modernized” (in a narrow sense of producing more and more unsanitary subjects and less and less sanitary citizens) and help to produce the conditions that create cholera. Another problem is the creation of images of dirtiness and primitiveness of these other people that lack hygiene and “modern habits”.

The images of the cholera were mainly produced by a knowledge highly medicalized by biomedical professionals, and disseminated by the media with almost no criticism to the types of images and stereotypes they (re)produce. There was a big contrast, according to Briggs, between the medical personnel in situ trying to keep indigenous and criollos alive, and the governmental anti-cholera campaign that was hegemonizing the information and were portraying the general image that the situation was under control. In these circumstances, a general racialization of death as “local” (cholera was always there) and “natural” (for the indigenous people) phenomenon was produced using narratives of modernity, science and hygiene (or lack of). So the information produced to the middle-class urban population was under strict governmental control and has a direct aim: to blame indigenous for their fault in contracting cholera.

For Briggs, a process of racializing and spatializing cholera was developed although it contradicts in itself when not only indigenous people but also criollos became affected. But the media rarely criticized the official discourse in relation to cholera, and when they did so, when they create what Briggs calls as “intertextual gap” and criticized the government, they implicitly assumed the rhetoric that racialized and spatialized cholera. Moreover, both physicians and media believed that indigenous people were incapable of understanding biomedical concepts or appropriating of hygienic practices according to their own perspective. The ultimate effect of the governmental and media message was a meta-communicative message: “if you die it is your fault”. In the same line that with the Peruvian case, Venezuela did only attack the symptoms but never embarked in attacking the structural causes: access to potable water and waste disposal, medical care and education, and reducing social inequality. 1991 and 1992 were critical years to the indigenous people, and specifically to their claims for land, human rights, and access to medical care so these struggles were overlapped with the cholera crisis and thus created an explosive situation in Delta Orinoco. Ultimately, the cholera crisis deepened the social and racial inequalities of the region.

I am trying to think on the double side of poverty-disease. It is a tricky exercise. On the one hand, people get sick because they “are” poor, and this means because they have an unequal “access” (this is a neutral word) to drinkable and potable water, to sewage systems, to education, to health services, to different part of the state. And then, on the other hand, people are poor because they “are” sick? This is the main corollary of neo-liberal policies at the regional, national and transnational levels. Briggs and Cueto show how cholera was stigmatized, racialized and spatialized in a very particular way. So one can assume that for many parts of the “society” (or whatever we may call it) the association is first, they are sick, second they are poor. All these types of stereotypes such as “they are filthy”, “they eat raw fish” (very different from sushi, that’s is cool), “they do not have any kind of hygienic habits”, are constantly (re)produced in the mass media and in the self-prophetical discourses of middle and upper classes that are (re)assured they are not like them, these others. But how are we going to take this knowledge, and act upon it? In both sides of the equation, poverty=disease, or disease=poverty people are actively engaging with these struggles over meaning, values, practices and actions. Said that, I still do not know how to work and produce a critique to this. Of course, showing these contradictions can help to see how the logic of disease=poverty is manipulated to cover up what we all know, that poverty=disease. But still, if we say so, we are somehow playing the game we do not want to play, which is to give a passive role to the subaltern (or whatever we may call it) that can only criticize this depiction of their reality but not actively produce a different space where to destroy and overcome these two logics.

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