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

In August 1992, cholera broke out in Mariusa, a community in the Venezuelan Orinoco delta primarily inhabited by Warao indigenas. This epidemic and its aftermath are brilliantly analyzed in this provocative book.

Causing violent diarrhea and vomiting, cholera can lead to death within hours. It is relatively easy to treat and prevent, but the Mariusans did not know that. Their healers could not cure them and outstanding narrators were unable to speak as terror made "a mockery of sense-making" (p. 77). When a highly respected healer died, Mariusans fled in panic. Some managed to reach a small clinic; in a central chapter of this book, physician Clara Mantini-Briggs describes the days she fought the dirt and smell of death here.

Too terrified to return to their homes, the survivors attempted to flee to a nearby city, but they were rounded up by the military and placed in quarantine. This not only violated their rights as Venezuelan citizens but also went against the recommendations of the World Health Organization (WHO): isolation cannot prevent cholera from spreading. The epidemic continued, but since doctors lacked essential laboratory equipment, they could not perform the tests necessary to confirm the cases, enabling officials to evade WHO requirements that cholera must always be reported. The actual number of victims is unknown; perhaps five hundred delta residents died from cholera during 1992 and 1993.

Other political and medical failures also made this catastrophe possible. The belated information campaigns that were launched were largely directed at middle-class Venezuelans. The indigenas, on the other hand, were blamed for spreading the disease: they were superstitious, ate raw shellfish, and refused modern hygiene. An "at risk" population was identified, as cultural and racial stereotypes were turned into scientific knowledge. Anthropological works—including Charles Briggs's own studies of Warao medical practices and songs—were used as evidence. Once identified, the ingredients of this discourse of blame kept circulating in the form of "stories, images, policies, manuals, and statistics" (p. xvi). But no blame was placed on governmental failures to provide people with clean water, schools, and health services.

Indigenas did not accept that they were at fault. They staged protest marches and explained the epidemic in alternate ways: it was caused by angry spirits (hebu), by illegal oil spills, by transnational commerce in the wake of the Gulf War, or by poisonous American "superbacteria." But the media ignored their marches and explanations—explanations that can be said to contain deep metaphoric truths at a time when global companies gained increasing hold on the world economy, a time when conditions worsened for many of the poor. For the people of the Orinoco delta, the cholera epidemic inaugurated a decade of mounting hardships, and many became homeless due to the expansion of the petroleum industry. Yet, little was done to improve their situation, and cholera struck again: in 1996, 1997, and 1998. Now even fewer medical resources than before were available; the media were silent as people were dying.

This is a voluminous book, rich in data, perspectives, and analytical linkages. Two topics are central. One is stories, storytelling, and the circulation of stories. Narrators are quoted at length and they step forward as complex individuals, be they cholera victims, vernacular healers, medical doctors, politicians, journalists, scholars, international health workers, priests, or others. It is by quoting and analyzing the words of storytellers that the authors show how the discourse of blame was constructed. Through the stories, they also present a nuanced picture of the multitude of voices and wills involved in the tragedy. In this way, they challenge all simplified dichotomies.

At the same time, however, the authors demonstrate how the discourse of blame can be understood in the light of a conceptual pair that constitutes another topic that is central to this book: sanitary citizens versus unsanitary subjects. Sanitary citizens are the moderns who understand...