Sex in Transition: Remaking Gender and Race in South Africa

Chapter 2: Medical Experimentation and the Raced Incongruence of Gender

Two Medical Experimentation and the Raced Incongruence of Gender [T]he military has a history of doing sex change operations—many sex changes were done in military hospitals. One has to ask to what extent it was experimental. Although in any medical advancement there is always a cutting edge of experimentation, in total institutions there is a captive audience. The question then reverts to one of “informed consent” and whether the choices people are given are limited because they cannot say “no.” (Van Zyl et al. in Kirk 2000d: 4) [“Specials”] are experimental sex changes. . . . I saw it. [The vagina] was now laying up her legs . . . and [it] actually looks like a raw tomato that’s sliced open and it’s just a hole . . . It heals, it heals. It just becomes, it’s almost like a piece of meat. It’s just a slit and then some sort of a hole there that they urinate from, and then at the bottom there’s some hole probably where penetration is supposed to take place, which they can’t even do. Now tell me, would you have that? (Baard 2000) During the transition to democracy, the Truth and Reconciliation Commission (TRC) revealed that apartheid medicine encompassed atrocities such as forced sterilization, nonconsensual experimentation, and medical torture. Africanist Meg Samuelson describes this context as providing “a space in which the liminal rituals of incorporation and group cohesion—rituals, in other words, of re-remembering—were performed” (2007: 2). In addition to changes concerning sexuality and gender mentioned previously, the 1996 South African Constitution brought new promises of health equity, including the rights “to have access to health care services” and “not to be subjected to medical experiments 77 78 / Sex in Transition without . . . informed consent.” These promises were not realized during the transition. This chapter explores medical experimentation on those who did not fit normative ideas of gender and sexuality under apartheid and the continuation of such abuses during the transition. Within this context, I problematize “consent” through a discussion of the tenuous agreement of those who are not fully informed about the risk of medical procedures and the context in which information is transferred, while also attending to the complications of autonomy, agency, and consent. As Antonio Gramsci (1971) pointed out, the interdependence of consent and force is integral to the production of hegemony. I define experimental medical procedures as ones carried out under controlled conditions to discover unknown effects; examples of this include the administration of medications with untested results and surgeries performed to test hypotheses about sex, gender, and/or sexuality. I argue that apartheid and poverty created health inequities that compelled those in greatest need to routinely and often unintentionally risk serious health complications in order to get medical care. I further suggest that with the configuration of apartheid and transition described in Chapter 1, some medical professionals capitalized on this demand to facilitate scientific advances and training at the expense of two marginalized groups of patients. Within African Studies, some of the most useful work in this realm has attended to the “traveling theory” of Michel Foucault’s biopower—the application of political power to control human populations, especially the body—in South African contexts. Megan Vaughan’s historical analysis of African medicine, for instance, considers the effectiveness of biopower, in terms of “how the body, in modern western society, has become both the site of, and constitutive of, power relations” (1991: 8). Vaughan outlines a critique of Foucault’s concepts based in the differences between the contexts in which he wrote and the power and knowledge regimes of colonial Africa, with particular attention to historical means of control and capitalism. More recent comparative analyses of Foucault’s notions in terms of HIV/AIDS are particularly relevant, as well. For Africanist Ulrike Kistner , while biopolitics constitutes a useful framework for conceptualizing African colonial medicine, [c]olonial power does not provide a sufficiently neat fit with the mode of power for whose analysis Foucault (prescriptively) Medical Experimentation and the Raced Incongruence of Gender / 79 describes a methodology. . . . Foucault’s methodology rests, among other things, on the presupposition of the continuity between individualising bio-power and regulating bio-politics, producing the ingredients of a society of normalization. (2003: 149–150) Similarly, Jean Comaroff, while noting the usefulness of Foucault and Giorgio Agamben’s analyses, also points to their limitations in analyses of HIV/AIDS in South Africa. Among...