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Healing the Body Politic

Healing the Body Politic: El Salvador's Popular Struggle for Health Rights from Civil War to Neoliberal Peace

Copyright Date: 2010
Published by: Rutgers University Press
Pages: 330
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  • Book Info
    Healing the Body Politic
    Book Description:

    Incorporating investigative journalism and drawing on interviews with participants and leaders, Sandy Smith-Nonini examines the contested place of health and development in El Salvador over the last two decades.Healing the Body Politicrecounts the dramatic story of radical health activism from its origins in liberation theology and guerrilla medicine during the third-world country's twelve-year civil war, through development of a remarkable "popular health system," administered by lay providers in a former war zone controlled by leftist rebels. This ethnography casts light on the conflicts between the conservative Ministry of Health and primary health advocates during the 1990s peace process--a time when the government sought to dismantle the effective peasant-run rural system. It offers a rare analysis of the White Marches of 2002û2003, when radicalized physicians rose to national leadership in a successful campaign against privatization of the social security health system.Healing the Body Politiccontributes to the productive integration of medical and political anthropology by bringing the semiotics of health and the body to bear on cultural understandings of warfare, the state, and globalization.

    eISBN: 978-0-8135-4925-5
    Subjects: Anthropology, Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-x)
    (pp. xi-xxii)

    In the first spring of the new millennium, eight years after the civil war, residents of San Salvador found themselves caught in an eerie déjà vu. On March 6, 2000, hundreds of riot police, in an action reminiscent of the war years, fired tear gas into a hospital emergency room occupied by protesting health workers, then stormed the building. At least two patients died in the chaos and dozens were injured. The violence came during a prolonged health strike that had paralyzed hospitals across the country as two medical unions protested President Francisco Flores’s plans to privatize social security health...

  5. Introduction: Theorizing the Body and the State
    (pp. 1-22)

    In this book I recount a series of underreported struggles over health rights in El Salvador that date to the beginnings of the civil war in the 1980s. I examine the potential for a nondualistic theory of the body politic, or what Bryan Turner (1992) has called “a biopolitics of the somatic society.” Used in this way, body politic refers to the implicit moral ecology and sense of social contract that gives meaning to representative governance and political legitimacy in nation-states. While much of my narrative focuses on a rural health movement that arose during the twelve-year civil war and...

  6. PART ONE Exclusion and the Politics of Bare Life

    • 1 Manufacturing Ill-being: An Epidemiology of Development and Terror
      (pp. 25-47)

      After the cease-fire when I began studying popular health in Guarjila, a resettled village of northeast Chalatenango, I initially talked to patients I met at the clinic and then asked permission to visit them at home for a follow-up interview. At the end of one such visit in the open-air dining area of an elderly woman’schampa, I stood to put my notebook away when Marta Ramos, who had been describing her granddaughter’s persistent cold, suddenly grabbed my arm and sat me down again. “Escucha!(Listen!),” she insisted, “I have to tell you this!” She erupted into the bloodcurdling tale...

    • 2 Repression’s Repercussions: Pragmatic Solidarity and the Body Politic
      (pp. 48-72)

      My excursions to Chalatenango from the capital began with a two-hour ride on a crowded bus. The Troncal Norte wound around the foothills of the extinct Guazapa volcano, a rebel stronghold during the war. The bus stopped briefly in bustling Aguilares, wherepupusastands lined the road, and young women assaulted the bus hawking El Salvador’s famous bean- or cheese-filled tortilla pies andrefrescos(fruit drinks) in bright bulging plastic bags. Here was the birthplace of the Comunidades Eclesiales de Base (CEB) or Christian base communities. Jesuit priests, inspired by the new Catholic social theology, organized thirty-seven CEB Bible groups...

  7. PART TWO War against Health

    • 3 Insurgent Health: How Liberation Theology and Guerrilla Medicine Planted the Seeds of “Popular” Health
      (pp. 75-97)

      The power to heal is the existential antithesis to the power to kill, and healing has been a common site of religious and political transformation in many cultures (Glick 1977). In Marxist traditions, Friedrich Engels’s 1845 study,The Condition of the Working Class in England, was the first scholarly effort to examine the health of the public as both materially related to capitalist expansion and a site for revolutionary struggle. For its part, Catholicism has traditionally regarded healing as representing the sacrament—“a sign of the healing Christ.” Hence, health institutions have long been central to the Church’s service to...

    • 4 Low-Intensity Conflict and the War against Health
      (pp. 98-121)

      The prologue of this book recounts my 1989 investigation of a Salvadoran army ambush of an FMLN mobile clinic. Witnesses and forensic evidence concurred that a U.S.-trained Special Forces unit quietly mounted a 60-mm gun on a ridge above the camp and methodically machine-gunned ten patients and health workers while soldiers chased down Mexican doctor Alejandra Bravo Betancourt and a lay nurse who fled the scene, raping, torturing, and killing both of them (Smith 1989a). While one of the more egregious cases, this was only one among scores of documented violations of international law protecting medical neutrality in the war....

    • 5 Pacification: Psychological Warfare and the Uses of Medicine
      (pp. 122-146)

      Military literature is replete with references to the fact that a properly fought low-intensity conflict (LIC) cannot stand public scrutiny and therefore must entail what U.S. general John Galvin (1990) calls a “war of information.” The problems of public scrutiny go far beyond security considerations; they result from LIC strategy of muddying the criteria dividing military combatants from civilians—the same vital distinction that forms the basis for international humanitarian laws on conduct in wars.

      Military analyst and LIC promoter Sam Sarkesian was particularly frank in warning of the difficulty in establishing a national consensus for unconventional conflicts, which he...

  8. PART THREE Health against War

    • 6 The Anatomy of “Popular Health” in the Repopulated Villages
      (pp. 149-170)

      Four months after the 1992 cease-fire, I began a study of the popular community health system that had developed (with assistance from the Salvadoran Catholic Church) in repopulated communities of northeast Chalatenango. Sometime after midnight on August 31, while sleeping in the back room of the clinic in Guarjila, I was startled awake by a baby’s shrill cries. In the examining room I found Esperanza, a peasant woman who had arrived the previous afternoon, wringing her hands while three health workers bent over a tiny infant. Tears coursed down Esperanza’s cheeks as Dr. Ana Manganaro, a Catholic sister and pediatrician,...

    • 7 The Elusive Goal of Community Participation
      (pp. 171-192)

      The famous 1978 Alma Ata international health conference, which elevated primary health care (PHC) to the level of international policy, established the year 2000 as the target year for achieving “Health for All.” As the millennium turned over, the failure to meet the goal received little fanfare in the media. For health development specialists, it was a failure long anticipated. By the 1990s the focus had shifted to neoliberal health reforms that placed emphasis on efficiency and individual responsibility for health and downplayed state involvement in primary care. By then a growing literature attested to failures of large-scale PHC programs...

  9. PART FOUR War by Other Means

    • 8 Popular Health and the State: Reasserting Biomedical Hegemony
      (pp. 195-219)

      Although most political analysts cited El Salvador’s legacy of inequality as a central cause of the war, the social reform goals of the revolution were only partially met after the 1992 cease-fire. FMLN achievements in the pact included demilitarization of the country, creation of a new civilian-controlled National Police, and a program to transfer land to ex-combatants and some squatter settlements. But in the rush to achieve a peace accord by December 31, 1991 (the end of mediator Pérez de Cuéllar’s term as UN secretary general), rebel leaders dropped demands for social welfare reforms. Details on many issues remained to...

    • 9 Disinvesting in Health: Multilateral Lending and the Clientelist State
      (pp. 220-236)

      The problematic peace process negotiations between the Ministry of Health and community health leaders in Chalatenango were not surprising given the strained political relations between the right-wing ARENA government and its former enemy, the FMLN, whose leaders remained popular in this former rebel stronghold. To gain a wider perspective, in fall 1995 I examined postwar changes in less controversial parts of the country, focusing on the two largest community health programs in El Salvador: the community health promoter (CHP) program in the Ministry of Health and the Maternal Health and Child Survival Project (known by its acronym, PROSAMI), which was...

    • 10 The White Marches: Healing the Body Politic
      (pp. 237-256)

      Vice President Dick Cheney’s description of El Salvador as a “success story” (see chapter 1) is a revisionist nugget that neatly sums up the two countries’ foreign relations in recent years—based on renovation of ARENA from the party of death squads to advocates for a neoliberal business model. Wielding control of the legislature during most of the 1990s, ARENA (allied with small parties on the right) oversaw the doubling of the GDP, proliferation in free trade zones, rampant privatizations of public infrastructure, and, in 2001, the switch from colones to dollars as the national currency. In the run-up to...

  10. Epilogue: Toward a Moral Politics
    (pp. 257-264)

    When I got off the bus in San José Las Flores, it was clear something was going on. The square was empty, but amplifiers waited next to chairs and tables under a canopy. A man set off bottle rockets near the church, where a crowd spilled out of the open doors. Inside, sunlight filtered through open windows; dozens of paper streamers danced in the breeze over the heads of villagers packed into pews. I marveled at the beauty of the reconstructed building that had been a ruin at the end of my field research, its roof fallen in from neglect...

  11. NOTES
    (pp. 265-274)
    (pp. 275-294)
  13. INDEX
    (pp. 295-306)
  14. Back Matter
    (pp. 307-308)