Stories in the Time of Cholera

Stories in the Time of Cholera: Racial Profiling during a Medical Nightmare

CHARLES L. BRIGGS
WITH CLARA MANTINI-BRIGGS
Copyright Date: 2003
Edition: 1
Pages: 456
https://www.jstor.org/stable/10.1525/j.ctt1pnmrd
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    Stories in the Time of Cholera
    Book Description:

    Cholera, although it can kill an adult through dehydration in half a day, is easily treated. Yet in 1992-93, some five hundred people died from cholera in the Orinoco Delta of eastern Venezuela. In some communities, a third of the adults died in a single night, as anthropologist Charles Briggs and Clara Mantini-Briggs, a Venezuelan public health physician, reveal in their frontline report. Why, they ask in this moving and thought-provoking account, did so many die near the end of the twentieth century from a bacterial infection associated with the premodern past? It was evident that the number of deaths resulted not only from inadequacies in medical services but also from the failure of public health officials to inform residents that cholera was likely to arrive. Less evident were the ways that scientists, officials, and politicians connected representations of infectious diseases with images of social inequality. In Venezuela, cholera was racialized as officials used anthropological notions of "culture" in deflecting blame away from their institutions and onto the victims themselves. The disease, the space of the Orinoco Delta, and the "indigenous ethnic group" who suffered cholera all came to seem somehow synonymous. One of the major threats to people's health worldwide is this deadly cycle of passing the blame. Carefully documenting how stigma, stories, and statistics circulate across borders, this first-rate ethnography demonstrates that the process undermines all the efforts of physicians and public health officials and at the same time contributes catastrophically to epidemics not only of cholera but also of tuberculosis, malaria, AIDS, and other killers. The authors have harnessed their own outrage over what took place during the epidemic and its aftermath in order to make clear the political and human stakes involved in the circulation of narratives, resources, and germs.

    eISBN: 978-0-520-93852-6
    Subjects: Anthropology

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. List of Illustrations
    (pp. xi-xiv)
  4. Preface
    (pp. xv-xx)
  5. Acknowledgments
    (pp. xxi-xxvi)
  6. Introduction: Death in the Delta
    (pp. 1-18)

    In 1992 and 1993 some five hundred persons died in the maze of rivers and thousands of large and small islands that form the delta region of the Orinoco River in eastern Venezuela (see map 1).¹ The disease that killed so many so quickly was cholera. I (Charles Briggs) stumbled onto the epidemic in November 1992 during a two-week visit to Tucupita, a city of some forty thousand inhabitants and the capital of Delta Amacuro state. Many of my friends from the delta were living on the streets of Tucupita and nearby Barrancas del Orinoco, another small city on the...

  7. 1 Preparing for a Bacterial Invasion: Cholera and Inequality in Venezuela
    (pp. 19-47)

    Peruvian public health officials formally notified their Venezuelan counterparts of the cholera epidemic in January 1991. The announcement generated immediate anxiety within the Ministerio de Sanidad y Asistencia Social (MSAS), the national agency responsible for Venezuelaʹs public health infrastructure. Although cholera was not officially reported in Venezuela for ten months, the disease became the primary focus of attention. MSAS became, to borrow Michael Taussigʹs pun, a nervous system.¹

    The national offices of MSAS are in the South Tower of Plaza Caracas (photograph 1), a complex that houses the bureaucracies responsible for national policies on immigration, culture, employment, justice, and taxation,...

  8. 2 Epidemic at the Door: Cholera Prevention in the Bureaucratic Imaginary of Delta Amacuro
    (pp. 48-58)

    As soon as authorities in Caracas learned of the cholera outbreak in Peru, they warned regional public health officials that a cholera epidemic was quite likely to emerge in Venezuela. In accordance with WHO and PAHO directives, MSAS required each state to set up an anti-cholera committee, which was charged with organizing health education campaigns and ensuring that medical institutions were prepared. National officials deemed cholera important enough to merit a week-long course on prevention and control of the disease, held in Caracas in mid-June 1991. Delta Amacuro was represented by its highest institutional officials: Dr. Magdalena Benavides, regional director...

  9. 3 Stories of an Epidemic Foretold: Cholera Reaches Mariusa
    (pp. 59-80)

    From the perspective of the residents of Tucupita, Mariusa is just plain off the map. Not only is it ʺinaccessible,ʺ it is the home of the most ʺisolatedʺ and ʺuncivilizedʺ of ʺthe Warao.ʺ Getting to Mariusa from Tucupita requires following the Mariusa River beyond Tortuga Island along a lengthy uninhabited stretch to the coastline (see map 1, page 2). The better-traveled route goes to Nabasanuka and Winikina and then through the Caribbean, which can be rough, dangerous, even impassable. Few government officials would even consider making the trip. Persistent requests by Mariusans over decades for a clinic, a school, a...

  10. 4 Fighting Death in a Regional Clinic: Cholera Arrives in Pedernales
    (pp. 81-97)

    On 2 August 1992, Daniel Rodríguez, the regional epidemiologist, and I (Clara Mantini-Briggs) were traveling along the Paseo Manamo, one of the larger streets in Tucupita. The river, on our right, was dotted with small boats. Some of the newer vessels were destroying the small-town serenity by traveling at substantial speed, while ancient vessels inched along like water-borne snails. On the other side of the street stretched a line of small mercantile establishments that included at least four liquor stores (photograph 10).

    A message on the portable radio in the jeep requested that Rodríguez proceed to the Regional Health Office....

  11. 5 Turning Chaos into Control: Initial Responses by Regional Institutions
    (pp. 98-137)

    While medical personnel in Pedernales were struggling to keep cholera patients alive, officials in the Regional Health Service were faced with the need to transform an anti-cholera ʺcampaignʺ that had died shortly after it was born in 1991 into a program capable of stopping the epidemic and convincing politicians and the public that the situation was under control—or at least would be very soon.

    One of the first priorities was to control the explosion of information. Residents of Pedernales saw patients being carted to the hospital as they heard a new word,cholera, buzzing around the community. Soon delta...

  12. 6 Containing an Indigenous Invasion: Quarantine in Barrancas
    (pp. 138-162)

    What became of the Mariusans after their exodus from a place that they had come to identify with death, terror, and uncertainty? They were fated to remain at the center of the storm; indeed, catastrophe seemed to follow them wherever they went. Some, about one hundred, traveled to the clinic in Nabasanuka, but most headed directly for Barrancas, their most frequent stop on routine trips to the mainland. With a hospital only a relatively short walk from the Orinoco River, Barrancas spelled safety. The Mariusans hoped thatcriollophysicians would know how to cure their strange new sickness.

    The Mariusans...

  13. 7 Exile and Internment: The Mariusans on La Tortuga
    (pp. 163-178)

    Barrancas officials did not succeed in sending back theindígenaswho were living along themalecónʺto their communities of origin.ʺ But the case of the Mariusan cholera refugees was different. They were identified as reservoirs of the disease, even after they had ingested antibiotics for two weeks, and Barranqueños didnʹt want them in their city. No one, other than the Mariusans themselves, seemed to be very worried about their constitutional rights. To stem the protests, Mayor Diego Escalante Castro found a way to get the Mariusans out of Barrancas and away from the probing gaze of reporters.

    Escalante and...

  14. 8 Medicine, Magic, and Military Might: Cholera Control on La Tortuga
    (pp. 179-198)

    The narratives told about the Mariusansʹ stay on La Tortuga often focused on hardship, the denial of constitutional rights, corruption, and protest, but it is crucial to keep in mind that their confinement was officially framed as a cordon sanitaire, a public health measure needed to eliminate a medical threat to thecriollobody politic. The medical effects of the quarantine were, at least for the target population, exactly the opposite. La Tortuga was in the middle of an area where cholera cases were spreading. The Mariusans initially were not provided with medical care, and their only source of drinking...

  15. 9 Culture Equals Cholera: Official Explanations for the Epidemic
    (pp. 199-223)

    No one in Delta Amacuro was prepared for cholera in the opening days of August 1992. Most communities in the fluvial area found themselves in the position of the Mariusans: they didnʹt know what the disease was, where it came from, how it was transmitted, or what to do about it. In contrast, public health authorities, politicians, and most residents of Tucupita and Barrancas knew that cases were being reported in nearby states and that an epidemic could emerge in Delta Amacuro. Yet almost nothing had been done to enable practitioners to respond swiftly to an outbreak.

    Talking and writing...

  16. 10 Challenging the Logic of Culture: Resisting Official Explanations for the Epidemic
    (pp. 224-255)

    Official narratives of crabs,hebuspirits, unsanitary habits, geographic isolation, immunological deficiency, and extinction were repeated by physicians, visiting epidemiologists, and just about everyone else. These dominant narratives—particularly the crab story—were sometimes turned on their head by activists, opposition politicians, and delta residents. Two obvious differences separated the alternative narratives from those told by government officials. First, thanks to the governmentʹs failure to launch a serious health education program, the disease generally arrived before the wordcholeraor any information on what it was or how to prevent and treat it. Second, delta residents immediately linked the disease...

  17. 11 Local Numbers and Global Power: The Role of Statistics
    (pp. 256-268)

    There is one area of institutional effort that seems to be maximally apolitical, authoritative, and safe: the collection and dissemination of health statistics. Yet these numbers play a central role in shaping how infectious diseases are perceived as global, national, or regional phenomena and in stratifying the position of nation-states in terms of the health of their populations. Here we have a global discourse par excellence, one that is produced by rural clinics, urban hospitals, and other ʺlocalʺ institutions and transmitted through global hierarchies to WHO, whose jurisdiction is the entire world.

    After it was founded in 1945, WHO became...

  18. 12 Sanitation and Global Citizenship: International Institutions and the Latin American Epidemic
    (pp. 269-297)

    Will the real global cholera expert please stand up?

    Quite a number of institutional players represented themselves as the bearers of perspectives that would modernize backward Tucupita and Barancas. Ironically, the modernity they proclaimed bore a strong resemblance to precisely the perspectives that international experts on cholera described as outmoded and ineffectual. These experts were employed by the leading international public health institutions and constituted the epitome of authority. They decided how cholera was defined, prevented, and treated worldwide, and they not only shaped the institutions that had access to cutting-edge technologies and epistemologies for studying cholera in the lab...

  19. 13 Virulent Aftermath: The Consequences of the Epidemic
    (pp. 298-332)

    Institutions had a central role in shaping the course of the cholera epidemic in Delta Amacuro. Complex linkages among regional, national, and international organizations crucially affected what took place in Mariusa, Tucupita, Caracas, and Geneva, and powerful institutional structures molded how statistics, manuals, reports, epidemiological analyses, laboratory results, and press reports were produced and circulated. After all was said and done—in Geneva, Washington, Atlanta, Caracas, and Tucupita—it was theindígenaswho overwhelmingly experienced the direct effects of the disease and its discursive shadow.

    Cholera continued to influence life even after its power to cause death had dissipated. Wakanoko,...

  20. Notes
    (pp. 333-372)
  21. Bibliography
    (pp. 373-404)
  22. Index
    (pp. 405-430)