El regreso de las epidemias: Salud y sociedad en el Peru del siglo XX (review)

Possessing vast natural wealth, Latin America has been systematically plundered for five hundred years. The catalog of depredations is well known for the colonial period: the demographic implosion of native Americans; a near-total expropriation of title to land; the plunder of gold, silver, diamonds, and all other mineral wealth; the imposition of plantation slavery and systematic forced labor; and the eradication of the spiritual and cultural life known in the pre-Columbian world. Since political independence from Iberia in the early nineteenth century, this exploitation has continued in a more sophisticated, but no less ruthless, process often referred to as underdevelopment. Despite enthusiastic adoption of neoliberal economics and the ideology of progress, Latin Americans—particularly native Americans and other nonwhite folk—have steadily suffered impoverishment.

A telling indicator of the “poverty of progress”¹ is the status of public health within present-day Latin America. Bearing witness to this, and serving almost as a case study in social injustice, is El regreso de las epidemias (which was corecipient in 1998 of the Premio Iberoamericano, awarded annually by the Latin American Studies Association to the best Spanish-language scholarly work on Latin America). Working his way through the history of epidemics—bubonic plague, yellow fever, typhus, smallpox, malaria, and cholera—in twentieth-century Peru, Marcos Cueto builds a powerful case for the relationship between “frustrated modernization” (p. 222)—that is, underdevelopment—and insalubrity.

Cueto argues that in the case of Peru, the disruption brought on by epidemics magnifies structural social inequities. First, epidemic diseases have had much greater impact, simply in terms of morbidity and mortality, among the have-nots in Peru. Second, the political response to epidemics has played a role in promoting the power of the state, further distorting social relations within the nation. Relying on extensive archival work in Peru, Spain, and the United States, Cueto is able to document these dynamics at work over the course of the century, and across the very distinct geographic zones—coastal, highlands, and jungle—that define Peru.

The chapter discussing the reliance of the dictator August Leguía on American experts (Henry Hanson and William Gorgas) and funding (the Rockefeller Foundation) to combat outbreaks of yellow fever in the 1920s documents well both parts of Cueto’s argument. Leguía’s readiness to put Hanson in charge of an anti-yellow-fever campaign allowed him to seem the humanitarian while winning favor with bankers that led to his and his family’s enrichment. But Hanson’s methods—which included restricting rice agriculture, interfering with daily commerce, and even banning community gatherings—were sufficiently stringent to provoke angry protest and civil disobedience by the rural poor.

That story foreshadows the response of the Fujimori government to the massive outbreak of cholera—more than 200,00 registered cases in 1992 alone—in the 1990s. In the chapter entitled “Blaming the Victims,” Cueto sets the stage for the epidemic. He documents a withering poverty that left Peru with the third worst infant mortality rate in Latin America, a per capita income 25 percent lower in 1990 than in 1988, and more than 1.5 million residents of greater Lima enduring the most marginal existence. Most importantly for the course of the cholera epidemic, one out of two Peruvians lacked access to proper sewerage, and in major cities such as Callao as many as 40 percent of the populace were forced to drink fecal-contaminated water.

The size of the epidemic, along with the rudimentary public health infrastructure, incapacitated the government. Hospitals were overwhelmed with patients, and only the coordinated efforts of the Catholic Church, grassroots organizations, and community-service groups such as firemen could begin to deal with the tens of thousands of sick people. The fact that cholera struck poor neighborhoods and spared well-off communities allowed the...