- Revolutionary Medicine: Health and the Body in Post-Soviet Cuba by P. Sean Brotherton
In recent years, there have been a burgeoning number of ethnographic studies situated in Cuba. Sean Brotherton is one of the first generation of anthropologists to conduct fieldwork in Cuba since Oscar and Ruth Lewis were (in)famously expelled from the country in the early 1970s. The opening of Cuba to foreign academic fieldwork is a direct result of the difficult political and economic circumstances in which the Revolutionary government found itself in the early 1990s. From the very beginnings of the Revolution, the Cuban state placed its domestic legitimacy on a tripod of interrelated institutional pillars: education, health, and sport. While education and sport have been addressed recently (Blum 2011, Carter 2008), Brotherton's study is a most welcome examination of this third leg of ideological legitimacy. Others have studied the Cuban health system, but no one has delved into the political dynamics of Cuba's universal health provision in the way that Brotherton has.
Revolutionary Medicine constructs its own analytical tripod. In the first section, Brotherton addresses the biopolitics of the Special Period: how this radically transformative time, unwanted and threatening as it was, changed the ways that Cubans thought of their health, the health system, and their relationship with the state. The second section examines the same issues from the government's perspective as it tried to maintain its legitimacy. Instead of individualized biopolitics, this section examines how the state tried to produce a healthy social and socialist body by creating medicalized subjectivities in an attempt to heal the "ills" of pre-revolutionary Cuba. In doing this, the government addressed social inequities but also engaged in strategic preventative measures to create a social body that would monitor its own condition and adjust accordingly [End Page 641] to maintain its Revolutionary "health." The third section examines how the state had to contradict and effectively undermine that revolutionary project by shifting some resources and priorities to attract foreign capital investment in order to keep the state and the fabric of society afloat. General practitioners became increasingly scarce as many went to work overseas for foreign currency salaries, and medical tourism developed as Cuban clinics recruited wealthy foreigners for specific procedures that also brought money to the health system's coffers.
Brotherton's astute recognition of the links between everyday socioeconomics, discourses of governance, and the politics of health situates the conditions of health not only as a biological condition but as a social one, making his ethnographic study powerfully evocative as the contradictions of Cuban life come to the fore. His study situates the provision of Cuban health care in the swiftly shifting political and economic circumstances of the Special Period when the state could not meet most of its citizens' basic needs as it had in the previous decades. That fraught context forced Cubans, on an everyday level, to devise alternative and new means of meeting their health care needs. At the same time, Brotherton also examines how the changing global contexts at the end of the US-Soviet Cold War necessitated a reshuffling of priorities within Cuba's health care system. Chronicling both the government's continuing internationalist strategies and forays in the global health care business through the promotion of health tourism, Brotherton captures the multifaceted object that is Cuba's health care system from a number of nuanced positions.
He argues that only by examining the interrelations of economic, ideological, and geopolitical discourses in the development of Cuba's contemporary public health system can one address the ways in which these discourses articulate and construct an image of a healthy nation. Specifically, one can see how Cuba's vital health statistics—as a reflection of the success of the country's socialist project—become part of a larger web of power relations. These relations feed into the geohistorical categories of First, Second, and Third World, whereby Cuba attained the status of a celebrated anomaly. Embedded within this global "development discourse" (to borrow Arturo Escobar's terminology...