Bulletin of the History of Medicine 78.1 (2004) 253-255
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Charles L. Briggs, with Clara Mantini-Briggs. Stories in the Time of Cholera: Racial Profiling during a Medical Nightmare. Berkeley and Los Angeles: University of California Press, 2003. xxvi + 430 pp. Ill. $34.95, £24.95 (0-520-23031-0).
This book is an important contribution to medical anthropology, and provides tools that are sorely needed in the recuperation of public health—for on a global scale, we are all in a state of emergency not so dissimilar to the cholera epidemic that overwhelmed residents of Venezuela's Orinoco delta in 1992. The accounts of the epidemic by anthropologist Charles Briggs and his physician coauthor Clara Mantini-Briggs are strengthened by their personal experience in the country's poor delta provinces during the outbreak. The authors provide a comprehensive account of the intersection between indigenous and clinical narratives about disease, race, and power, and conclude with an astute analysis of reemerging infectious disease and poverty in the context of transnational neoliberal economics and the politics of globalization.
Briggs, the principal author, centers the book around what he calls "medical profiling": racialized public and professional narratives about the mostly indigenous "victims" of the Venezuelan epidemic. Ironically, cholera need not be fatal if patients are orally rehydrated, yet in Delta Amacuro, a state long neglected in public health outreach and national budgets, hundreds of Warao villagers died in a matter of months. The book documents the role of official public health authorities and of the media in dividing the public into "sanitary citizens," with [End Page 253] complex identities and nationality intact, and "unsanitary subjects," whose identity became reduced to stereotypes of race or class and associated with a predictable package of cultural beliefs and behaviors (p. 33).
Venezuelans initially encountered cholera in the form of nationalist claims and rumors from remote borderlands—cholera literally threatened the body politic, violating borders and puncturing the image of modernity and scientific notions of progress so carefully cultivated by the government. In the delta region, where the outbreak was most deadly, the indigenous population became cast in public statements and media accounts as an orientalist "other" set in contrast to, and outside of, the national project. Official narratives privileged cultural and behavioral explanations of the deadly epidemic (e.g., inadequate cooking, poor hygiene) that individualized its impact and laid the blame on its victims. Such accounts, the authors note, decentered other interpretations, such as those based on underfunded sanitary and health infrastructure or the land and labor exploitation that have made poverty and malnutrition endemic to the delta.
The text is replete with examples showing how the gaze of the media and health authorities tended to fixate on exotic features such as indigena spiritual and magical beliefs about the origins and treatment of disease—but in fact, as Briggs and Mantini-Briggs show, there were counternarratives for those who sought them out. For example, the failure of male indigenous healers to cure the deadly diarrhea actually enhanced the power of women in the villages. As a result, women became the primary repositories of cultural memory about the epidemic.
In a cautionary note to anthropologists, Briggs lays out the pitfalls of what he calls "cultural reasoning," in which the notion of culture becomes decontextualized and invoked in explaining complex issues. Such explanations risk becoming objectified as common knowledge and appropriated in institutional ideologies. Used in this way, he warns, cultural reasoning acquires a "liberal patina [which] helps disguise timeworn stereotypes and institutional agendas," and provides a framework for racial profiling (p. 318).
The authors illustrate how the epidemic became appropriated by dissident political parties (including supporters of Hugo Chavez), who denounced the rising poverty that belied elite promises of the development that would arise from the country's petroleum reserves. The unheard narratives of indigenous people themselves tended to focus on the lack of resources and power, and often betrayed a distrust of governmental authority.
Ironically, Venezuelan health administrators found themselves in a defensive posture—...