Read the Brondo article #6.1: “An Anthropology of Structural Violence" and answer the reflection questions.
1. Reflecting on the article “An Anthropology of Structural Violence”
- After finishing the module and all of the reading, explain in your own words your understanding of the concept of "violence," and how violence relates to culture.
- After reading Paul Farmer's article, explain your understanding of the concept of structural violence. According to this article, how does structural violence play into health issues in Haiti?
- Read again carefully the last two paragraphs of this article. What justifications were given by the U.S. officials in the Department of the Treasury and the U.S. Agency for International Development (USAID) to NOT invest U.S. resources in AIDS therapy for Africa? Why is Farmer so troubled by these justifications?
Questions
- France’s refusal to accept the loss of so “efficient” and profitable a colony led, ultimately, to the expedition of the largest armada ever to cross the Atlantic. After the 1803 Battle of Vertires, in which Napoleon’s troops were defeated, Haiti was declared an independent nation. But its infrastructure lay in ruins: some estimate that more than half of the island’s population perished in the war. The land was still fertile, if less so than when the Europeans began mono cropping it, and so the new republic’s leadership, desperate to revive the economy, fought to restore the plantations without overt slavery….Even if there were other ways of growing these products—and coffee, unlike sugar, was clearly a product that could be grown on small homesteads—who would buy them? The Europeans and the only other republic in the Western Hemisphere, the United States, were the only likely customers, and they mostly followed a French-led embargo on Haiti. How many people in France remember that, in order to obtain diplomatic recognition, Haiti was required to indemnify France to the tune of 150 million francs to the government of Charles X beginning in 1825? One hundred fifty million francs in reparations to the slave owners, a social and economic fact redolent with meaning then and today and one with grave material consequences for the Haitians….This set the tone for the new century: trade concessions for European and U.S. partners and indirect taxes for the peasants who grew the produce, their backs bent under the weight of a hostile world. Especially hostile was the United States to the north, the slave-owning republic (Lawless 1992: 56).The United States blocked Haiti’s invitation to the famous Western Hemisphere Panama Conference of 1825 and refused to recognize Haitian independent until
- This isolation was imposed on Haiti by a frightened white world, and Haiti became a test case, first for those arguing about emancipation and then, after the end of slavery, for those arguing about the capacity of blacks for self-government.In the years following independence, the United States and allied European powers helped France orchestrate a diplomatic quarantine of Haiti, and the new republic soon became the outcast of the international community….But the isolation was largely diplomatic and rhetorical…. The United States was increasingly present as a trading partner and policeman…. Continuous U.S. naval presence led, eventually, to an armed occupation of Haiti in
- This occupation, another chapter of U.S. history now almost completely forgotten by the occupiers, was to last 20 years….Since 1915, at the latest, the United States has been the dominant force in Haitian politics. The modern Haitian army was created, in 1916, by an act of the U.S. Congress. From the time of troop withdrawal in 1934 until 1990, no Haitian administration has risen to power without the blessing of the U.S. government…. Indeed, there have been no major political discontinuities until perhaps 1990, with the result that the template of colony—a slave colony—continued to shape life in Haiti. Just as the wealthy were socialized for excess, the Haitian poor were socialized for scarcity….This is the framework I had in mind when I began studying specific infectious diseases—one old, one new—in rural Haiti. In anthropology a version of this framework has been called “world systems theory” (Wallerstein 1974)…. It is an approach that is committed to ethnographically embedding evidence within the historically given social and economic structures that shape life so dramatically on the edge of life and death. These structures are transnational, and therefore not even their modern vestiges are really ethnographically visible….The public health infrastructure is of special concern to me. In the past decade I have witnessed two related processes in central Haiti: the collapse of the public health sector and the overwhelming of the hospital of which I am the medical director. Even if our hospital were uninterested in seeking foreign aid in the conventional sense, we would desperately be awaiting the rebuilding of the Haitian health system…. We have read the Durban declaration, which calls for reparations to postslavery societies. We agree that this hemisphere’s poorest country is also and not coincidentally its largest postslavery society. Cuba would be in second place. Guess which two Western Hemisphere republics are under an aid embargo? Does anyone think that Haitians, at least the ones I live with, do not see the continuity between the current and previous embargoes?“What embargo?” one may well ask. “Imposed on Haiti? By whom?” Since the Haitian elections of 2000, the U.S. government has used its influence with international lending institutions such as the Inter-American Development Bank to withhold already approved loans earmarked for development and improving health, education, and water quality in Haiti….… Take as an example Inter-American Development Bank (IDB) Loan No. 1009/SFHA, Reorganization of the National Health System. On July 21, 1998, the Haitian government and the IDB signed a $22.5-million loan for phase 1 of a project to decentralize and reorganize the Haitian health care system. The need to improve the health care system was and remains urgent: there are 1.2 doctors, 1.3 nurses, and 0.04 dentists per 10,000 Haitians; 40% of the population is without access to any form of primary health care. HIV and tuberculosis rates are by far the highest in the hemisphere, as are infant, juvenile, and maternal mortality. To use the bank’s jargon, the project was to target 80% of the population for access to primary health care through the construction of low cost clinics and local health dispensaries, the training of community health agents, and the purchase of medical equipment and essential medicines….Ratification of the loan agreement was initially held up by Haiti’s famously obstructionist 46th Legislature, whose goal was clear enough within Haiti to paralyze all social services, including health care, in order to undermine every effort of the executive branch … to improve the living conditions of the poor majority that had elected him by a landslide….In October 2000, after the installation of the more representative 47th Legislature, the new parliament voted immediately to ratify the health project along with the three other vital IDB loan agreements. Nevertheless, by early March 2001, the IDB had not yet disbursed the loan but announced that it fully intended to work with the new Aristide government and to finance projects already in the pipeline. It demanded, however, that a number of conditions be met, requiring the poorest nation in the hemisphere to pay back millions of dollars of outstanding debts racked up by the previous U.S.-supported dictatorships, as well as “credit commissions” and interest on undisbursed funds. For example, as of March 31, 2001, Haiti already owed the IDB $185,239.75 as a commission fee on a loan it had never received. The total amount of fees owed on five development loans from the IDB was $2,311,422. Whereas in the nineteenth century Haiti had had to pay reparations to slave owners, at the start of the twenty-first century a different sort of extortion was being practiced to ensure that Haiti not become too independent. The health loan has still not been disbursed and thus the embargo on international aid to Haiti continues, despite the fact that the Haitian government has followed all the stipulations set down for resolving the disputed elections. In the meantime, the courtyard around our hospital remains overflowing—that is the ethnographically visible part.These details about loans and such may seem pedestrian to an academic audience. They certainly would hold no great interest for me were it not for their direct and profound impact on the bodies of the vulnerable (Farmer 2003). Trust me, they are of life-and-death significance.For those reluctant to trust a physician-anthropologist on this score, one has only to consider the case of Anite, dying of metastatic breast cancer. She inhabits a world in which it is possible to visit 14 clinics without receiving a diagnosis or even palliative care. The contours of this world, a world in which her options and even her dreams are constrained sharply, have been shaped by the historical and economic processes described in this paper….Creating Mirages: Erasing Biology… Tuberculosis and AIDS cause millions of premature deaths every year. These two pathogens are, in fact, the leading infectious causes of adult death in the world today….An anthropological understanding needs to be … both biological and social. Let me illustrate with the better-known of the two diseases: Tuberculosis was long called “the white plague,” and it is widely believed that it arose with the industrial revolution and then faded. As the historian Katherine Ott notes, however, “Tuberculosis is not ‘resurgent’ to those who have been contending with and marginalized by it all their lives” (1996: 49). A third of the world’s population is infected with the causative organism. We can expect 8–10 million cases a year, with 2–3 million deaths.How would a critical anthropology look at tuberculosis? Unfortunately, much of the work to date has been focused on the “cultural beliefs,” as they are termed, of the victims of tuberculosis. In Haiti, for example, anthropologists have hastened to note that the locals often regard tuberculosis as a disease sent by sorcery …I took up this question of folk belief some decades later and discovered that many of the terms used in late-twentieth-century Haiti came right out of the slave plantations (Farmer 1992). In the Central Plateau, ethnographic research conducted in the 1980s revealed that tuberculosis was seen as “sent” by sorcery by the majority of those afflicted. A decade later, after an effective tuberculosis treatment program was put in place, Didi Bertrand and others noted that tuberculosis was increasingly seen as an airborne infectious disease. More to the point, it was seen as treatable, and the stigma associated with it was clearly on the wane.This indissociable trio of anthropology, history, and biology is just as readily evident when we look closely at the world’s most recent plague and the complex trajectory of its causative agent—a virus, in this case. Since the syndrome was first described, AIDS has also been termed a “social disease” and has been studied by social scientists, including anthropologists…. When AIDS was first recognized, in the early eighties, it was soon apparent that it was an infectious disease, even though other, more exotic interpretations abounded at the time. Well before Luc Montagner discovered HIV, many believed that the etiologic agent was a never-before described virus, and people wanted to know, as they so often do, where this new sickness came from. During the eighties the hypotheses circulating in the United States suggested that HIV came to the United States from Haiti. Newspaper articles, television reports, and even scholarly publications confidently posited a scenario in which Haitian professionals who had fled the Duvalier regime ended up in western Africa and later brought the new virus back to Haiti, which introduced it to the Americas. AIDS was said to proliferate in Haiti because of strange practices involving voodoo blood rituals and animal sacrifice.These theories are ethnographically absurd, but they are wrong in other ways, too. First, they happened to be incorrect epidemiologically. AIDS in Haiti had nothing to do with voodoo or Africa. Second, they had an adverse effect on Haiti—the tourism industry collapse in the mid-eighties was due in large part to rumors about HIV, and on Haitians living in North America and Europe. The perception that “Haitian” was almost synonymous with “HIV-infected” in the minds of many U.S. citizens, has been well documented….How, then, was HIV introduced to the island nation of Haiti? An intracellular organism must necessarily cross water in a human host. It was clear from the outset that HIV did not come to Haiti from Africa. None of the first Haitians diagnosed with the new syndrome had ever been to Africa; most had never met an African. But many did have histories of sexual contact with North Americans. In a 1984 paper published in a scholarly journal, the Haitian physician Jean Gurin and colleagues revealed that 17% of their patients reported a history of sexual contact with tourists from North America (Gurin, Malebranche, and Elie et al. 1984). These exchanges involved the exchange of money, too, and so sexual tourism—which inevitably takes place across steep grades of economic inequality—was a critical first step in the introduction of HIV to Haiti….There is more, of course, to the hidden history of AIDS in Haiti. By the time HIV was circulating in the Americas, Haiti was economically dependent not on France, as in previous centuries, but on the United States. From the time of the U.S. military occupation through the Duvalier dictatorships (1957–86), the United States had come to occupy the role of chief arbiter of Haitian affairs. After the withdrawal of troops in 1934, U.S. influence in Haiti grew rather than waned. U.S.-Haitian agribusiness projects may have failed, deepening social inequalities throughout Haiti as the rural peasantry became poorer, but U.S.-Haitian ties did not. Haiti became a leading recipient of U.S. aid, and the United States and the “international financial institutions” were the Duvalier family’s most reliable source of foreign currency. Haiti became, in turn, the ninth largest assembler of U.S. goods in the world and bought almost all of its imports from the United States. Tourism and soustraitance (offshore assembly) replaced coffee and other agricultural products as the chief sources of foreign revenue in Haiti.Haiti is the extreme example of a general pattern. If one uses trade data to assess the degree of Caribbean basin countries’ dependency on the United States at the time HIV appeared in the region, one sees that the five countries with the tightest ties to the United States were the five countries with the highest HIV prevalence. “… AIDS in Haiti is a tale of ties to the United States, rather than to Africa; it is a story of unemployment rates greater than 70 percent. AIDS in Haiti has far more to do with the pursuit of trade and tourism in a dirt poor country than with, to cite Alfred Mtraux, … dark saturnalia celebrated by ‘blood-maddened, sex-maddened, god-maddened’ negroes” (Farmer 1992: 264).But this was merely the beginning of a biosocial story of the virus. The Haitian men who had been the partners of North Americans were by and large poor men; they were trading sex for money. The Haitians in turn transmitted HIV to their wives and girlfriends. Through affective and economic connections, HIV rapidly became entrenched in Haiti’s urban slums and then spread to smaller cities, towns, and, finally, villages like the one in which I work. Haiti is now the most HIV-affected country in the Americas, but the introduction and spread of the new virus has a history—a biosocial history that some would like to hide away.Like many anthropologists, I was not always careful to avoid stripping away the social from the material. But HIV, though hastened forward by many social forces, is as material as any other microbe. Once in the body, its impact is profound both biologically and socially. As cell-mediated immunity is destroyed, poor people living with HIV are felled more often than not by tuberculosis. Last year, HIV was said to surpass tuberculosis as the leading infectious cause of adult death, but in truth these two epidemics are tightly linked….All this is both interesting and horrible. What might have been done to avert the deaths caused by these two pathogens? What might be done right now? One would think that the tuberculosis question, at least, could be solved. Because there is no nonhuman host, simply detecting and treating promptly all active cases would eventually result in an end to deaths from this disease. Money and political will are what is missing—which brings us back to structural violence and its supporting hegemonies: the materiality of the social.AIDS, one could argue, is thornier. There is no cure, but current therapies have had a profound impact on mortality among favored populations in the United States and Europe. The trick is to get therapy to those who need it most. Although this will require significant resources, the projected cost over the next few years is less than the monies allocated in a single day for rescuing the U.S. airlines industry (see Swoboda and McNeil [Hamilton] 2001). But the supporting hegemonies have already decreed AIDS an unmanageable problem. The justifications are often byzantine. For example, a high-ranking official within the U.S. Department of the Treasury (who wisely declined to be named) has argued that Africans have “a different concept of time” and would therefore be unable to take their medications on schedule; hence, no investment in AIDS therapy for Africa. The head of the U.S. Agency for International Development later identified a lack of wristwatches as the primary stumbling block. Cheap wristwatches are not unheard of, but, as I have said, the primary problem is a matter of political will….The distribution of AIDS and tuberculosis—like that of slavery in earlier times—is historically given and economically driven. What common features underpin the afflictions of past and present centuries? Social inequalities are at the heart of structural violence….