27 Aug ICCG #3

After weeks of struggling with the reason for placing blame in the cholera outbreak in Haiti, i finally landed on an argument that makes sense to me, and, hopefully, makes sense to others, as well. This was never about the “blame game”, rather, was deeply imbedded in geopolitical wranglings of an order that is beyond our own individual scope… For context, please see the previous two posts.

Cholera has been touted as a disease of poverty. Yet, as Charles Briggs points out (2005), narratives about epidemics that naturalize racial and other inequalities, “as if bacteria and viruses gravitate toward populations and respect social boundaries” (272), grant agency to microbes and responsibility to the sick.

At the same time, a renewed discourse of the unsanitary subjects emerges through this naturalization – Haitians as failing to engage as appropriately self-regulating, modernized, health-mindful citizens who practice appropriate hygiene (Briggs, 2005; Briggs & Martini-Briggs, 2003; Ong, 1995). Foucault reminds us that “it is in discourse that power and knowledge are merged together” (1990, 100), and it is within this re-invigorated discourse of Haitians as unsanitary actors that power is made manifest.

By placing the blame on Haitian individuals, as a group, there is a turn away from engaging in a dialogue about the larger overarching patterns of structural violence. Paul Farmer and Arthur Kleinman point out, in AIDS and human suffering (1989) there are strong differences between global north  and global south understandings of responsibilization of blame. “Alcoholics, those dependent on drug, smokers who have developed emphysema, obese victims of heart attacks, chronic pain patients, even some sufferers from cancer – those who bottle up anger or who unbottle high-fat, low-fiber diets – all are seen as personally accountable for their disorders. Illness is said to be the outcome of their free choice of high-risk behavior.

In contrast, in Haiti and in many African and Asian societies, where individual rights are often underemphasized and also frequently unprotected, and where the idea of personal accountability is less powerful than is the idea of the primacy of social relations, blaming  the victim is also a less frequent response to AIDS” (1989; 146).

It is in this context that I choose to move forward with the question of Cholera in Haiti.

Blaming the victim was a popular trope, not just amoung the UN and MINUSTAH public policy faces, but in public discourse, as well. But within the population of Haiti, there is a much stronger recognition of the greater structural and overarching forces which not only create the overwhelming conditionalities necessary for the invasion of this epidemic, but also for the socio-political discourses that would support and not question the introduction of the disease.

As Paul Farmer so eloquently laid out in AIDS and accusation: Haiti and the geography of blame:

North American responses to Haitians are embedded in a tendency to blame victims, endemic racism, and a folk theory of Haitians that depicts them as both exotic and infected – infected because they are exotic, exotic because they are infected.

There is in this discourse, a naturalization of not only the disease itself, but of Haitians to be infected with the disease. Within discourses of cholera, there is a kind of “proof of a moral failure to conduct oneself in a rational , informed manner” (Briggs, 2005). If anything, there was in popular media and even scientific journals simply curiosity, or even disbelief, that the country had not experienced cholera outbreaks in the past. As it is, 16% of Haitian children die before age of five of diarrheal diseases. Haitians, through the sheer force of their poverty, were already included in the “risk group” – exotic and diseased and somewhere out there.

Risk, as a term, works to investigate and classify people and places as objects of governmental interest, particularly poor people and poor places (Lea & Stenson, 2007: 9). By reducing patterns of inequality to “risk-factors”, there is a distraction from the greater structural disorders that exacerbate health ailments (Farmer 2001). This is not to say that understanding risk-factors in relation to structural violences is not useful in understanding the disparity in health measurements at various scales, rather, there has been a tendency to use risk as a function of governmentality which works to discriminate against populations (Nguyen & Peshard, 2003). It is through the quantification of risk-factors that issues of health and disease are moved into the body of the patient as well as into the body of particular populations and out of the public sphere of responsibility. Thus, the value-laden enactment upon risk evaluation is transferred to populations as blame and is assigned to poor populations to both “apportion responsibility and demand accountability” (Freedman 2005: 530). Thus, “[t]he impact of risk culture on individual and collective conduct raise questions of trust in abstract systems and expertise and problematizes individual and collective security” (Dean, 1996: 209). In this, the person becomes problematized as a risk, not the social structures which create the risks.

Social determinants of risk, then, are not seen as a product of structural inequalities, but as products of social(ized) irresponsibility – in this case, an irresponsibility of the Haitian people to (choose your own adventure), not the UN Stabilization Mission or the Nepalese Army. The classification of risk medicalizes social inequality on the body which then works to create categories of populations of particular risk which must be targeted for intervention (and subsequently, warrant surveillance) – thus in many ways, re-legitimizing the UN occupation even as the Haitian people decried its illegitimacy as evidenced by their poor “bio-responsibility”.

So it is that we return to the question of understanding the origin of the disease outbreak. While, on the one hand, the containment of cholera in Haiti most assuredly was the prime target for resources (and well should have been), there was still, for Haitians and for others, a need to be able to pinpoint the direct cause. It is here that we turn to Matt Sparke who states, “in more ethically exacting terms, we have a critical responsibility to resist the pathologization of place by describing the global processes of dispossession that account for local efforts at repossession” (Sparke, 2008, 434). What the UN and the Nepalese army failed to recognize was that Haitians’ desire to know the culprit was not about constructing a scapegoat, rather, was deeply tied to their political frustrations mounted within the post-disaster humanitarian crisis and the continued occupation by UN peace keeping troops.

What circulated in the victim-blaming discourses was a recurring theme of vulnerability – vulnerability to the disease, vulnerability to disaster, and vulnerability to their own lack of a sense of a sanitary self.

As Chris Philo (2005) points out, the difficulty with turning toward a geography of vulnerability is that it moves the focus toward “those peoples and places reckoned to be vulnerable. It is something about them, about their intrinsic characteristics or properties…that renders them vulnerable to something bad happening” (443). In doing this, then, there is a turn away from the larger contextual and relational processes which produce or perpetuate vulnerability, to natrualise it, pulling it out of the sphere of human control and into a space of being an inevitable and unstoppable force (Philo, 2005: 443).