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

Cholera, like so many diseases, affects populations that are the most vulnerable. In order to understand why cholera killed over five hundred indigenous Warao in the Delta Amaruco of Venezuela during the summer of 1992, Charles Briggs and Clara Martini-Briggs have painstakingly collected narratives from the Warao, local physicians, public health officials, politicians and international epidemiologists from the World Health Organization and the Pan American Health Organization. From a careful analysis of their narratives there emerges a picture of unequal relations based on race, class, gender and politics that have relegated the Warao to an inferior position, thus serving as a tragic example of what is increasingly happening to more and more people all over the world.

What makes this book exceedingly important is that the authors have been able to present a clear juxtaposition of different narratives. These stories give voice not only to those who became ill but also to the different people involved in treating them: those who collected epidemiological statistics, reported for the local and national press, performed political damage control, limited the migration of people from the Delta to local urban areas, and worked in public health, among others. This is perhaps the first time that so many voices have been heard. In turn, it has enabled the authors to show the polarization of viewpoints and the deeply engrained beliefs about why people get sick and how they should be treated. For the elites and other non-indigenous peoples of the Delta Amaruco, the Warao are viewed as unsanitary, unhealthy and uncivilized. Because of their cultural habits, which allegedly include eating raw crabs, the Warao are seen as being guilty of bringing the deadly disease on themselves and thus should bear the primary responsibility for their own high morbidity and mortality rates. Ill Warao were regarded as a threat and thus kept geographically isolated or quarantined to prevent the "civilized population" from getting infected. At the same time, Vibrio cholerae was regarded as an "invasion" into Venezuela that reached the Warao from other infected areas of South America and the rest of the world. The threat of infection led to rapid action by public health authorities, yet the very limited medical supplies rushed to the Delta were not made available until the disease had taken its considerable toll. The efforts were predicated on wiping out the pathogen and isolating the ill to protect the healthy.

In direct contrast to the narratives of the "civilized population," the Warao spoke out forcefully about the illness and their inability to avoid infection. Many sought treatment from their own native healers; when these, too, became sick and died there was widespread fear and panic. Whole populations left their communities and migrated to nearby cities and towns, where they were immediately seen as a threat. Many were forcibly relocated back to their native lands only to face hopelessness and a renewed risk of infection. Once the epidemic abated, public health authorities felt that their work was done, that once again a dreaded disease had been successfully defeated despite the negative cultural practices of the Warao.

The authors point out that cholera could have been prevented through educational campaigns on disease prevention, such as boiling water and other practices to reduce the risk of infection. However, the central issue is the increasing gap between the rich and the poor and the unwillingness to institute reforms to redistribute wealth and create greater equity. Part of achieving this end is to have the voices of the Warao heard as a counterpoint to the rhetoric of blaming the victim. This book should be on the reading list of anyone who is concerned with globalization and issues of racism, equity, and the wellbeing of marginalized populations.