atlanta-based charities give american agribusiness the finger
and in other news, this article is completely awesome. i know i wrote a lot of not flattering stuff about care below, but i really did like working for them, and i'm definitely not smart/perceptive enough to have picked up on that aspect of development. and of course, reading good things about care and the carter center makes me feel all warm and gooey inside. in a good way
of course i'm middle class, aren't you?
so this weekend, i was talking with a group of very intelligent friends of mine about progressivism, politics and america's class structure (among other topics). and an extremely intelligent, thoughtful, progressive and caring friend of mine said (and i paraphrase), "the middle class serves as a weight to prevent excessive volatility [which he understood as essentially bad] in the electoral cycle/politics. the current erosion of the middle class--the increased inequality/stratification of class structure in america--is possibly/probably leading to dictatorships of both the right and the left."
now because i'm picky and obsessed with discourse (and post-structuralism and all that), i immediately spoke up, basically saying that the middle class is both a myth and a rhetorical tool (or are these often the same thing? i'm not in a position to say), a grouping which lacks almost any unifying feature (and certainly anything that can be defined by the vast majority of those to whom it is applied) and an identity which both (nearly) everyone (in america) and no one applies to her/himself. you know, really succinct and well-phrased and -reasoned and all, just like that. anyways, i wasn't really satisfied with what i said at the time (i'd had a few drinks in me by then), so i would feel better if i wrote some of it out here, just to get it in written form, with proper grammar and un-slurred words and all that fun stuff.
so the first part is "what is the middle class?" in america, we're taught from a very early age all about self-reliance, how anything is possible if we try and how our (financial and social) failures are our own damn faults. we're taught about the acres of diamonds (sorry for the pop-ups, but i'm always surprised the number of people that have never heard of that, since i remember it very clearly from high school american history), pulling ourselves up from our bootstraps, social mobility and whatnot. the corollary of which being that if we're all able to completely change our standing in our own lives, by our own agency, we're neither impoverished (and thus stuck in a poverty so deep that we cannot escape) nor exceedingly wealthy (and thus so well off that we will never need to worry about our wealth, no matter how poorly we might spend it). we're all middle class. of course. now, mind you, i have no real statistical tests to back up my claims, but i've got some fancy excel-generated graphics from the folks over at wikipedia, which im for the sake of convenience going to assume to be accurate. anyways, what it basically shows, if you look at the graph right under "income distribution", is that rather than following any sort of "normal curve", the distribution is heavily skewed to the left (poverty), tapering off dramatically at the right (extreme wealth--also, keep in mind that the top two columns are actually in increments of $50k, rather than $10k, so there's not really a "bump" at the right). elsewhere on the page (actually, immediately above) it defines the "middle 33%" of income (i think this is the median rather than the mean, but its not really clearly stated) as between $30k and $62.5k. so that's theoretically the "middle class" there, i suppose, possibly including something on either end, or excluding, depending on how big a middle class you want there. looking at the graph, there's very little there to suggest that the middle class exists as a separate "population", or can even be at all statistically defined. well, duh, its a sociological term, right? the main point is, that there is no break, nor even a "bump" on the graph to suggest that there exists, in the distribution of incomes in the US, a distinctive tri-part division of "classes". it would have been nice to have found a normal curve, thus dividing it into the bump and two tails, but that's not happening. what we do see is, after an initial steep increase in incidence (denoting relatively few people in extreme poverty), a nice, gradual slope down from a large section of the population which is relatively poorer to a small segment that is relatively richer.
ok, so i even did a little background research (on wikipedia, again, sorry), and read a bit further down the table to the part about "social class". distilling it a bit, it basically assumes a strong correlation between occupation, education, income and some place on the "social hierarchy". which is probably fair enough, but it's good to note those assumptions, since i'm gonna pick on them a few paragraphs further on. anyways, the thing i wanted to note is the division between classes (four here)--upper, middle, working and lower (poor). anyways, the upper class are households with an income of "$500k or more", the middle class are those "with incomes considerably above-average [sic]", the working class are those with "little economic security" and the poor are those in poverty, basically (the national poverty line for a family of four (and of course we're assuming 2.5 kids here) in 2006 was $20k). so there's that.
ok, but what is the middle class meant to be? i would assume that most people would assume that "class" is some sort of identity, and that's a convenient (for my analysis, of course) assumption, i think. identities are things that link people--people sharing identities live in similar places, work in similar jobs, participate in similar activities, share a common worldview and socialize with each other (to the exclusion, of course, of those outside that identity). in many ways, the middle class is a perfect example of identity--the middle class can often be found in suburban and light-urban areas, they work in safe service-industry jobs, they often join athletic leagues, book clubs, neighborhood associations and, above all, work to raise the next generation (or at least say they do) and usually their friends are people they live near, people they work with and people they know through their activities. in america, i think it would be pretty easy to jump to the assumption that this middle class is overwhelmingly white, straight and english-speaking. so what is special about a class, relative to other identities (white, american, male, southern, gay, etc.)? the essential thing is that class is explicitly hierarchical. while it would be pretty easy to say that men are "ranked" above women in this society, and straights above gays, and whites above blacks, and so on and so forth, class is more than anything a way of telling you, explicitly and in no uncertain terms, where you stand in society. even more explicity, it is a way of ranking, from 1 to 280,000,000, how important each person is to society. someone of the extreme upper class is "more important" (to whom? to what? to society, and to all of us, it would seem) than someone living in a medium-sized home in a suburb, and then that person is more important again than someone living in a slum, or living on the street.
so, while all identities are hierarchical, this one which is both internally and externally ascribed (i believe i am of a certain class, and others, depending on their experiences, will believe i am of a certain class, and often these will align, though many times they will not) is the one for which it is most necessary to keep in mind the relative and exclusionary nature of identities--i am gay because i am not straight, i am woman because i am not man, i am white because i am not black, i am rich because i am not poor. i am middle class because i am not...either really wealthy or really poor? ok, so maybe the "middle class" then constitutes more a sort of "norm" than any sort of essntial "identity". maybe, perhaps in the way that all "norms" almost constitute some "unmarked identity", it's actually both (see the essay below about women and the Other, i guess, since i can't put footnotes in here easily). so its maybe a norm that acts like an identity, in some cases. which then i suppose accounts for the fact that it's in no way statistically the majority or even statistically visible. ok, fine. point conceded. but i think the more important thing is that it is thought of as something between both, in that it is certainly the "norm" in american society, but it is still something that is positively ascribed, many, many people actively assume themselves to be part of it while other facets of their lives--income, occupation, neighborhood, etc.--will tend to point them away from being "middle class".
so what does this say politically? i would assume that most other identities and norms tend to group people who vote similarly. the problem is that, in the american electorate, i would assume that income is a fairly poor indicator of political leanings. most blacks are more socially conservative than i, though they would disagree with whites with similar incomes on the topic of government expenditures and foreign policy, i would assume. those of the middle class are split geographically and racially, along the lines of religion, language and general upbringing. many have commented previously on how the "republicans have tricked the poor [whites] into voting against their economic interests". if economic interests are indeed the most important determinants of voting behavior, then the rich should invariably vote for conservatives espousing zero redistribution and the poor invariably for liberals espousing robin hood policies. and then the middle class should be left somewhere in the middle either opting for no redistribution, or maximum redistribution, or something in the middle, i guess, depending on their place in the middle class, their route to arrive there, their aspirations, their mood, and of course the prevailing winds, to name but a few. but that's not really the case, voting (and politics) is determined by ideology, not pure economic calculations. and, at least in my view, ideology is fundamentally not about someone's experience with the world, but the way in which that person has been taught to view the world. which is passed down between old and young, and young and young, and old and old, and young and old, through religion, through education, through casual chats at the supermarket.
so then what would a large middle class really have to do with promoting "moderation" in government? and what effect does the increase in inequality have on a middle class that is more an ideal than an actual fact? if we all believe we're middle class anyways, does it really matter if we are or not if we're actually voting with our heads and not our wallets? i'm gonna go ahead and say "not much, not much, and no".
so the middle class is a construction then, fine. i feel like i've proven it to myself, though the above essay seems a bit incoherent to actually convince many others, i guess. just because it's a construction, not an essential, "real" object, doesn't mean that it's not real. it's real because our culture gives it significance and weight and because that weight carries power. it's a discursive strategy, that allows for self-evident piece of "moderation". society is then defined, because of course the middle class must be the norm, as something which tends towards its center, needing balance between both the right and the left. if society were actually a binary division, rather than a two-tailed normal curve, the middle would need not exist, and thus neither would compromise, similarly, if society is skewed one way or another, it would detract from those who either advocate or fight against redistribution (depending on the skew of society). the "middle class" is thus a placation strategy. and because society then "tends towards its center", it inherently sustains its status quo. for me, in many ways, the "middle class" is complacency on a number of issues, usually revolving around/stemming from poverty and inequality, which really don't demand complacency or compromise, but action. radical revolution if you will, or if you won't, perhaps a large-scale redistribution of wealth. but the fact remains that the "middle class" remains a rhetorical strategy of postponement and maintenance of the status quo.
god, i sound like such a marxist, reading back on this. catch us next time for another exciting episode of "workers of the world, unite!"
now because i'm picky and obsessed with discourse (and post-structuralism and all that), i immediately spoke up, basically saying that the middle class is both a myth and a rhetorical tool (or are these often the same thing? i'm not in a position to say), a grouping which lacks almost any unifying feature (and certainly anything that can be defined by the vast majority of those to whom it is applied) and an identity which both (nearly) everyone (in america) and no one applies to her/himself. you know, really succinct and well-phrased and -reasoned and all, just like that. anyways, i wasn't really satisfied with what i said at the time (i'd had a few drinks in me by then), so i would feel better if i wrote some of it out here, just to get it in written form, with proper grammar and un-slurred words and all that fun stuff.
so the first part is "what is the middle class?" in america, we're taught from a very early age all about self-reliance, how anything is possible if we try and how our (financial and social) failures are our own damn faults. we're taught about the acres of diamonds (sorry for the pop-ups, but i'm always surprised the number of people that have never heard of that, since i remember it very clearly from high school american history), pulling ourselves up from our bootstraps, social mobility and whatnot. the corollary of which being that if we're all able to completely change our standing in our own lives, by our own agency, we're neither impoverished (and thus stuck in a poverty so deep that we cannot escape) nor exceedingly wealthy (and thus so well off that we will never need to worry about our wealth, no matter how poorly we might spend it). we're all middle class. of course. now, mind you, i have no real statistical tests to back up my claims, but i've got some fancy excel-generated graphics from the folks over at wikipedia, which im for the sake of convenience going to assume to be accurate. anyways, what it basically shows, if you look at the graph right under "income distribution", is that rather than following any sort of "normal curve", the distribution is heavily skewed to the left (poverty), tapering off dramatically at the right (extreme wealth--also, keep in mind that the top two columns are actually in increments of $50k, rather than $10k, so there's not really a "bump" at the right). elsewhere on the page (actually, immediately above) it defines the "middle 33%" of income (i think this is the median rather than the mean, but its not really clearly stated) as between $30k and $62.5k. so that's theoretically the "middle class" there, i suppose, possibly including something on either end, or excluding, depending on how big a middle class you want there. looking at the graph, there's very little there to suggest that the middle class exists as a separate "population", or can even be at all statistically defined. well, duh, its a sociological term, right? the main point is, that there is no break, nor even a "bump" on the graph to suggest that there exists, in the distribution of incomes in the US, a distinctive tri-part division of "classes". it would have been nice to have found a normal curve, thus dividing it into the bump and two tails, but that's not happening. what we do see is, after an initial steep increase in incidence (denoting relatively few people in extreme poverty), a nice, gradual slope down from a large section of the population which is relatively poorer to a small segment that is relatively richer.
ok, so i even did a little background research (on wikipedia, again, sorry), and read a bit further down the table to the part about "social class". distilling it a bit, it basically assumes a strong correlation between occupation, education, income and some place on the "social hierarchy". which is probably fair enough, but it's good to note those assumptions, since i'm gonna pick on them a few paragraphs further on. anyways, the thing i wanted to note is the division between classes (four here)--upper, middle, working and lower (poor). anyways, the upper class are households with an income of "$500k or more", the middle class are those "with incomes considerably above-average [sic]", the working class are those with "little economic security" and the poor are those in poverty, basically (the national poverty line for a family of four (and of course we're assuming 2.5 kids here) in 2006 was $20k). so there's that.
ok, but what is the middle class meant to be? i would assume that most people would assume that "class" is some sort of identity, and that's a convenient (for my analysis, of course) assumption, i think. identities are things that link people--people sharing identities live in similar places, work in similar jobs, participate in similar activities, share a common worldview and socialize with each other (to the exclusion, of course, of those outside that identity). in many ways, the middle class is a perfect example of identity--the middle class can often be found in suburban and light-urban areas, they work in safe service-industry jobs, they often join athletic leagues, book clubs, neighborhood associations and, above all, work to raise the next generation (or at least say they do) and usually their friends are people they live near, people they work with and people they know through their activities. in america, i think it would be pretty easy to jump to the assumption that this middle class is overwhelmingly white, straight and english-speaking. so what is special about a class, relative to other identities (white, american, male, southern, gay, etc.)? the essential thing is that class is explicitly hierarchical. while it would be pretty easy to say that men are "ranked" above women in this society, and straights above gays, and whites above blacks, and so on and so forth, class is more than anything a way of telling you, explicitly and in no uncertain terms, where you stand in society. even more explicity, it is a way of ranking, from 1 to 280,000,000, how important each person is to society. someone of the extreme upper class is "more important" (to whom? to what? to society, and to all of us, it would seem) than someone living in a medium-sized home in a suburb, and then that person is more important again than someone living in a slum, or living on the street.
so, while all identities are hierarchical, this one which is both internally and externally ascribed (i believe i am of a certain class, and others, depending on their experiences, will believe i am of a certain class, and often these will align, though many times they will not) is the one for which it is most necessary to keep in mind the relative and exclusionary nature of identities--i am gay because i am not straight, i am woman because i am not man, i am white because i am not black, i am rich because i am not poor. i am middle class because i am not...either really wealthy or really poor? ok, so maybe the "middle class" then constitutes more a sort of "norm" than any sort of essntial "identity". maybe, perhaps in the way that all "norms" almost constitute some "unmarked identity", it's actually both (see the essay below about women and the Other, i guess, since i can't put footnotes in here easily). so its maybe a norm that acts like an identity, in some cases. which then i suppose accounts for the fact that it's in no way statistically the majority or even statistically visible. ok, fine. point conceded. but i think the more important thing is that it is thought of as something between both, in that it is certainly the "norm" in american society, but it is still something that is positively ascribed, many, many people actively assume themselves to be part of it while other facets of their lives--income, occupation, neighborhood, etc.--will tend to point them away from being "middle class".
so what does this say politically? i would assume that most other identities and norms tend to group people who vote similarly. the problem is that, in the american electorate, i would assume that income is a fairly poor indicator of political leanings. most blacks are more socially conservative than i, though they would disagree with whites with similar incomes on the topic of government expenditures and foreign policy, i would assume. those of the middle class are split geographically and racially, along the lines of religion, language and general upbringing. many have commented previously on how the "republicans have tricked the poor [whites] into voting against their economic interests". if economic interests are indeed the most important determinants of voting behavior, then the rich should invariably vote for conservatives espousing zero redistribution and the poor invariably for liberals espousing robin hood policies. and then the middle class should be left somewhere in the middle either opting for no redistribution, or maximum redistribution, or something in the middle, i guess, depending on their place in the middle class, their route to arrive there, their aspirations, their mood, and of course the prevailing winds, to name but a few. but that's not really the case, voting (and politics) is determined by ideology, not pure economic calculations. and, at least in my view, ideology is fundamentally not about someone's experience with the world, but the way in which that person has been taught to view the world. which is passed down between old and young, and young and young, and old and old, and young and old, through religion, through education, through casual chats at the supermarket.
so then what would a large middle class really have to do with promoting "moderation" in government? and what effect does the increase in inequality have on a middle class that is more an ideal than an actual fact? if we all believe we're middle class anyways, does it really matter if we are or not if we're actually voting with our heads and not our wallets? i'm gonna go ahead and say "not much, not much, and no".
so the middle class is a construction then, fine. i feel like i've proven it to myself, though the above essay seems a bit incoherent to actually convince many others, i guess. just because it's a construction, not an essential, "real" object, doesn't mean that it's not real. it's real because our culture gives it significance and weight and because that weight carries power. it's a discursive strategy, that allows for self-evident piece of "moderation". society is then defined, because of course the middle class must be the norm, as something which tends towards its center, needing balance between both the right and the left. if society were actually a binary division, rather than a two-tailed normal curve, the middle would need not exist, and thus neither would compromise, similarly, if society is skewed one way or another, it would detract from those who either advocate or fight against redistribution (depending on the skew of society). the "middle class" is thus a placation strategy. and because society then "tends towards its center", it inherently sustains its status quo. for me, in many ways, the "middle class" is complacency on a number of issues, usually revolving around/stemming from poverty and inequality, which really don't demand complacency or compromise, but action. radical revolution if you will, or if you won't, perhaps a large-scale redistribution of wealth. but the fact remains that the "middle class" remains a rhetorical strategy of postponement and maintenance of the status quo.
god, i sound like such a marxist, reading back on this. catch us next time for another exciting episode of "workers of the world, unite!"
on "what the hell am i doing"?
so: health education is a load of shit.
well, maybe i should revise that: teaching people to be healthy is the most moronic idea ever.
but with this qualification: so, i'm, uh, gonna be working to run a health education and resource centre in a slum in india for the next few years. but i'm sure this time, i'll get it right where everyone else as failed. because this is going to be different.
yeah, right.
so the deal is that in a month or two im headed back to pune, india to work for the next few years to help get a "health education and resource centre" going and to work there day-to-day. it's with an organization i've been working on-and-off with for the last few years. they started a home for street children, run a program to encourage girls' education in the neighboring slum and now are branching out to do something about health there. tuberculosis, anemia, diarrheal disease and any other manner of preventable morbidity and mortality are pretty huge issues there, and to make things worse, the indian government programs that would theoretically make a huge dent in the incidence of all this are pretty much completely ineffective, simply not providing the services they are meant to provide as their raison d'etre.
but anyways, back to the health education is crap thing. yeah, it's good to impress upon people (and especially small children, but we'll get to that later) the importance of handwashing to prevent the spread of a lot of diseases (by the deliciously poetic (in spanish) cycle of ano-mano-boca). people should know that their diet should include a wide variety of nutrients, and in sufficient quantities.
but i can't teach how to avoid tuberculosis--the best way is really to not know anyone with tuberculosis. covering your mouth when you cough isnt sufficient, because the drops can hang in the air for hours, they don't need to be sucked up directly. and i can't teach you how to not get active tb once you've been infected, since that really depends on your nutrition and general "constitution" for lack of a better word. and teaching people nutrition in a "development" context is really just a joke. i mean, wtf, can you figure out a way to have a balanced diet when your ingredients consist of potatoes, some vegetable oil (that may or may not be fortified with vitamins A and E) and salt (that probably isn't iodized)? trust me, for most people in most of the places where nutrition is seriously lacking, no amount of education is going to make even the smallest difference in their diet, because they're already stretched to the limit of survival.
so basically, the best way to teach people to be healthy is to teach them not to be poor, right? and now that definitely sounds like a ridiculous idea. unless you're a republican and you believe that poor people are just lazy. but anyways, to look further at the example of tuberculosis (which i've been obsessing over quite a bit lately), let's think of the things that structure your risk of dying of tb. first you've got to get infected. let's leave that one alone for the time being (since its pretty much impossible to prevent someone from giving you tb, it's easier to look at it from the point of view of the already-infected person spreading it, rather than someone "catching" it). next, your infection has to become "active". ie, it has to go from a few mycobacteria harmlessly chilling in your lungs to a bunch of mycobacteria going crazy multiplying and punching holes in all manner of tissues and organs. a brief list of conditions that tend to increase the risk of tuberculosis progressing from "latent" to "active":
so i took the liberty of bolding the conditions that are way more likely to be present in marginalized, and especially impoverished, groups, for pretty obvious reasons. the conditions in italics can in a number of ways be linked to poverty, but i'm gonna leave them alone since they're less relevant to what i generally am working with. the others can basically be either attributed to medical treatments (and previous medical treatments are pretty much completely unknown where i'm working) or "other conditions" that aren't specific enough for me to actually know what's being talked about. but basically there are a few conditions--HIV, previous active TB disease and malnutrition--which are hugely more prevalent in poor populations, especially in Pune. so poor people are certainly more likely to progress to active tb disease once infected than most others. then, they're less likely to be treated at all, and if they are treated, treatment is like to be inconsistent, poorly-designed, poorly-implemented or implemented in such a way as to be completely insulting, or any combination of the above. there are financial and geographic barriers to treatment--medicines are expensive, hospitals are not located in slums and time off from work...well, only if you don't mind not getting paid that day. poor people (in india certainly) are often treated like shit in the hospital, made to wait long hours (8 hours, easily), insulted and generally treated without any human dignity. migrants (a large population in the yerwada slum) are further left out--the hospital signs are only in marathi and english, not hindi, which most migrants speak (english is the language of the educated and the wealthy, and marathi is the state language of maharashtra--hindi is spoken by most people, at least in northern and central india, as well as the language which is "local" to their place of origin). often service is even completely denied because a person is from a "criminal tribe" and thus "addicted to crime"--from birth, apparently. and the DOTS program, which demands that people are "directly observed" in taking their medications, thus ensuring compliance and completion, demands that the patients go to the DOTS office at least 3 times a week, if not every day, to take their medications, rather than health workers distributing medications even near their homes. so yeah, its an uphill climb for treatment. in such an environment, it's hard to imagine many poor people even beginning treatment, let alone finishing it successfully--which then leads to drug resistance. and any active, untreated case of pulmonary tuberculosis is contagious. so if you're poor, not only are you more likely to fall ill and not be treated, but you're also more likely to know other people who have fallen ill and have not been treated, thus leading you to be much more likely to be infected in the first place. it's pretty easy to see how tuberculosis has been relegated to the history books in affluent places, but is still rampant in most poor places, especially where people are highly concentrated.
and so it goes. so basically what i want to do, what i will do, is to interrupt that chain at every point. which doesn't really involve "health education" at all. we have to educate people, yes, to recognize sympoms of tb, but more we need to educate and mobilize them to demand treatment from already-estabilished government programs that theoretically provide free treatment but simply suck at it. we need to break down barriers to treatment, but also treat the conditions that put people at risk--poverty, lack of social mobility, lack of basic services, in essence, the lack of all the "basic necessities" that we learn about in first grade: food, water and shelter. we will be improving health by working to combat prejudice and discrimination and by working for women's empowerment. keeping kids in school through secondary and higher education will lessen their chances of dying of tuberculosis. as it will for most any other disease.
so then, are we actually going to teach? yeah, we will. we will teach people to wash their hands. fine, but to assume that by just pouring in this knowledge will improve anything is ridiculous. that could work with children, but to teach adults and even adolescents to simply wash their hands is treating them like children. there are very specific reasons that most of them have never washed their hands regularly--lack of soap, lack of water, and even that handwashing has simply never been a priority because there are much more immediate causes of morbidity and mortality to worry about. we're probably going to have to give out soap, and fight tooth and nail for more water connections in people's houses.
yeah, we're going to be teaching, but that's just the beginning of what we need to do. we need to provide for a basic level of subsistence sufficient so that they can apply what they've learned.
well, maybe i should revise that: teaching people to be healthy is the most moronic idea ever.
but with this qualification: so, i'm, uh, gonna be working to run a health education and resource centre in a slum in india for the next few years. but i'm sure this time, i'll get it right where everyone else as failed. because this is going to be different.
yeah, right.
so the deal is that in a month or two im headed back to pune, india to work for the next few years to help get a "health education and resource centre" going and to work there day-to-day. it's with an organization i've been working on-and-off with for the last few years. they started a home for street children, run a program to encourage girls' education in the neighboring slum and now are branching out to do something about health there. tuberculosis, anemia, diarrheal disease and any other manner of preventable morbidity and mortality are pretty huge issues there, and to make things worse, the indian government programs that would theoretically make a huge dent in the incidence of all this are pretty much completely ineffective, simply not providing the services they are meant to provide as their raison d'etre.
but anyways, back to the health education is crap thing. yeah, it's good to impress upon people (and especially small children, but we'll get to that later) the importance of handwashing to prevent the spread of a lot of diseases (by the deliciously poetic (in spanish) cycle of ano-mano-boca). people should know that their diet should include a wide variety of nutrients, and in sufficient quantities.
but i can't teach how to avoid tuberculosis--the best way is really to not know anyone with tuberculosis. covering your mouth when you cough isnt sufficient, because the drops can hang in the air for hours, they don't need to be sucked up directly. and i can't teach you how to not get active tb once you've been infected, since that really depends on your nutrition and general "constitution" for lack of a better word. and teaching people nutrition in a "development" context is really just a joke. i mean, wtf, can you figure out a way to have a balanced diet when your ingredients consist of potatoes, some vegetable oil (that may or may not be fortified with vitamins A and E) and salt (that probably isn't iodized)? trust me, for most people in most of the places where nutrition is seriously lacking, no amount of education is going to make even the smallest difference in their diet, because they're already stretched to the limit of survival.
so basically, the best way to teach people to be healthy is to teach them not to be poor, right? and now that definitely sounds like a ridiculous idea. unless you're a republican and you believe that poor people are just lazy. but anyways, to look further at the example of tuberculosis (which i've been obsessing over quite a bit lately), let's think of the things that structure your risk of dying of tb. first you've got to get infected. let's leave that one alone for the time being (since its pretty much impossible to prevent someone from giving you tb, it's easier to look at it from the point of view of the already-infected person spreading it, rather than someone "catching" it). next, your infection has to become "active". ie, it has to go from a few mycobacteria harmlessly chilling in your lungs to a bunch of mycobacteria going crazy multiplying and punching holes in all manner of tissues and organs. a brief list of conditions that tend to increase the risk of tuberculosis progressing from "latent" to "active":
- Infection with HIV, the virus that causes AIDS
- Injection of illicit drugs
- Recent TB infection (within the past 2 years)
- Chest x-ray findings suggestive of previous TB
- Diabetes mellitus
- Silicosis
- Prolonged therapy with corticosteroids
- Immunosuppressive therapy
- Certain types of cancer (e.g., leukemia, Hodgkin's disease, or cancer of the head and neck)
- Severe kidney disease
- Certain intestinal conditions
- Low body weight (10% or more below ideal)
so i took the liberty of bolding the conditions that are way more likely to be present in marginalized, and especially impoverished, groups, for pretty obvious reasons. the conditions in italics can in a number of ways be linked to poverty, but i'm gonna leave them alone since they're less relevant to what i generally am working with. the others can basically be either attributed to medical treatments (and previous medical treatments are pretty much completely unknown where i'm working) or "other conditions" that aren't specific enough for me to actually know what's being talked about. but basically there are a few conditions--HIV, previous active TB disease and malnutrition--which are hugely more prevalent in poor populations, especially in Pune. so poor people are certainly more likely to progress to active tb disease once infected than most others. then, they're less likely to be treated at all, and if they are treated, treatment is like to be inconsistent, poorly-designed, poorly-implemented or implemented in such a way as to be completely insulting, or any combination of the above. there are financial and geographic barriers to treatment--medicines are expensive, hospitals are not located in slums and time off from work...well, only if you don't mind not getting paid that day. poor people (in india certainly) are often treated like shit in the hospital, made to wait long hours (8 hours, easily), insulted and generally treated without any human dignity. migrants (a large population in the yerwada slum) are further left out--the hospital signs are only in marathi and english, not hindi, which most migrants speak (english is the language of the educated and the wealthy, and marathi is the state language of maharashtra--hindi is spoken by most people, at least in northern and central india, as well as the language which is "local" to their place of origin). often service is even completely denied because a person is from a "criminal tribe" and thus "addicted to crime"--from birth, apparently. and the DOTS program, which demands that people are "directly observed" in taking their medications, thus ensuring compliance and completion, demands that the patients go to the DOTS office at least 3 times a week, if not every day, to take their medications, rather than health workers distributing medications even near their homes. so yeah, its an uphill climb for treatment. in such an environment, it's hard to imagine many poor people even beginning treatment, let alone finishing it successfully--which then leads to drug resistance. and any active, untreated case of pulmonary tuberculosis is contagious. so if you're poor, not only are you more likely to fall ill and not be treated, but you're also more likely to know other people who have fallen ill and have not been treated, thus leading you to be much more likely to be infected in the first place. it's pretty easy to see how tuberculosis has been relegated to the history books in affluent places, but is still rampant in most poor places, especially where people are highly concentrated.
and so it goes. so basically what i want to do, what i will do, is to interrupt that chain at every point. which doesn't really involve "health education" at all. we have to educate people, yes, to recognize sympoms of tb, but more we need to educate and mobilize them to demand treatment from already-estabilished government programs that theoretically provide free treatment but simply suck at it. we need to break down barriers to treatment, but also treat the conditions that put people at risk--poverty, lack of social mobility, lack of basic services, in essence, the lack of all the "basic necessities" that we learn about in first grade: food, water and shelter. we will be improving health by working to combat prejudice and discrimination and by working for women's empowerment. keeping kids in school through secondary and higher education will lessen their chances of dying of tuberculosis. as it will for most any other disease.
so then, are we actually going to teach? yeah, we will. we will teach people to wash their hands. fine, but to assume that by just pouring in this knowledge will improve anything is ridiculous. that could work with children, but to teach adults and even adolescents to simply wash their hands is treating them like children. there are very specific reasons that most of them have never washed their hands regularly--lack of soap, lack of water, and even that handwashing has simply never been a priority because there are much more immediate causes of morbidity and mortality to worry about. we're probably going to have to give out soap, and fight tooth and nail for more water connections in people's houses.
yeah, we're going to be teaching, but that's just the beginning of what we need to do. we need to provide for a basic level of subsistence sufficient so that they can apply what they've learned.
Are you my Other? Alterity, Feminism and Identity Politics
Alterity, as a specific condition, cannot be said to exist. The Other, the mythical figure of “what one is not”, is not exactly a rigid category. To say what I myself am, I must look (first?) to what I am not. In defining myself, I demarcate my own boundaries, inscribing borders around that which is “not-me”, constituting the Other and thereby constituting myself in relation to what is my antithesis. I am tall because I am not short, I am white because I am not black (though “non-white” proves more troublesome), I am a man because I am not a woman. But by inscribing borders around the “not-me”, I also mark decisively what is neither me, nor the other, but beyond language and imagination (or at least beyond consideration in the matter at hand). To perhaps be more clear, there is the problem that in constituting my opposite, I map too directly my experience onto that of the other, assuming a strict(er) yes-no binarism of characteristics, separating the Other from the Not-Me by defining borders which are excessively self-reflexive.
Though these two very different conceptions of otherness—the defined, carefully circumscribed and bounded Other and the messier, infinite Not-Me—are found (often confused) throughout discussions of alterity (the postcolonial Other of Said and Spivak, the political other of ACT-UP in New York, the unknown Other of development discourse, etc.), I choose here to focus on the discursive space between Beauvoir’s (more conservative) definition of the Other[1] and Irigaray’s radical rejection of the Other as so much of the same, opting for a more radical notion of unbounded identity-space, the Not-Me, which is not automatically reflective of the subject (which is assumed, by both authors, to be the male). In taking these two authors as examples of types of alterity, I will obviously concentrate on the construction of woman as the marked Other or Not-Me, and the discursive space between these different constructions, leading to a discussion of the work done by this undefined discursive space in the construction of women as “at risk” (or not) in the American AIDS epidemic, as well as a brief look at the exportation of this discursive baggage abroad, especially to Africa since the early 1990’s (since Western Europe and North America entered a post-crisis period in their (responses to their) AIDS epidemics). The first two sections will necessarily consist of a close reading of Beauvoir’s and Irigaray’s works, especially The Second Sex and This Sex Which Is Not One, while employing a critical understanding of gener as made explicit by Butler in the opening chapters of Gender Troubles and other works in that field. After these, there will a look at the use of the Other and the Not-Me understandings of alterity in responses to the AIDS epidemics in the
“A matter of form”
Beauvoir, in opening The Second Sex, finds that she cannot write of women without writing of their eternal referent, men. After a brief discussion of the problems of defining women essentially, Beauvoir touches on the most problematic point of her treatise: the need for its explanation.
A man would never set out to write a book on the peculiar situation of the human male. But if I wish to define myself, I must first of all say: ‘I am a woman’; on this truth must be based all further discussion. A man never begins by presenting himself as an individual of a certain sex; it goes without saying that he is a man. The terms masculine and feminine are used symmetrically only as a matter of form, as on legal papers (1949: 15).
In stating her case from an initial point of specificity, Beauvoir (and the reader) is immediately aware of the reference which is made by the term woman: that which is not man. In marking its referent, the signifier “woman” always-already inscribes itself as an Other, just as it always-already implies the category of “man”. As such, these two terms can be seen as reflective, the one constituting the lack of the other and vice-versa (though this construction would seem to imply an equality of signification, that is certainly and emphatically not the case). The category “woman” is defined as a marked subset of humanity, inscribing all those to whom the category “man” (seen as the natural, ideal, or unmarked) does not apply with a marker of their difference: this person is not male because of this difference, this person must then be female. Beauvoir compares this to the definition of the oblique based on a concept of the absolute vertical (1949: 15), though later she expands this: the absolute vertical is also defined by the lack of obliqueness. “Thus it is that no group ever sets itself up as the One without at once setting up the Other over against itself” and “the subject can only be posed in being opposed—he sets himself up as the essential, as opposed to the other, the inessential, the object” (1949: 17). The two terms, the One and the Other, become inextricably linked, impossible to exist individually and ultimately reflections of each other: equally opposite if not equal and opposite.
Beauvoir’s woman is also inextricably linked to man:
The bond that unites her to her oppressors is not comparable to any other…The couple is a fundamental unity with its two halves riveted together, and the cleavage of society along the line of sex is impossible. Here is to be found the basic trait of woman: she is the Other in a totality of which the two components are necessary to one another (1949: 19-20).
Thus in constructing their highly relative identities, the One and the Other, these identities become indivisible, each existing to reflect and define the other while being completely dependent on each other, materially and existentially. Beauvoir constructs her marked Other (or occasionally, Object) as a definite foil which throws light and definition onto the characteristics of the Subject (man), that that construction may remain defined without being marked by its specificity: man is the universal, the “judge and party to the case” (1949: 27). Butler calls this the “closed circuit of signifier and signified” (1990: 15), in which the signifier “woman” refers directly to woman but also implies the masculine. To borrow the vocabulary of Irigaray (with more to come in the next section), the thoroughly patriarchal (or phallogocentric) language used to signify the feminine always-already implies and necessitates the masculine, locking the two (masculine/feminine) into a necessary and unavoidable binary, with each being defined by its reflection of the O/other. Beauvoir essentially limits her definition of the other to that which is useful for the production of a coherent identity, an Other which only exists with the One and vice versa.
Multiplying sex, exploding the Other
Irigaray categorically rejects this notion of the Other (as being untrue, as being unhelpful, as being un-whole). Through her analysis, the notion of the Other being always-already constituted as part of the One (to re-borrow Beauvoir’s terminology) is posed as extremely limiting. In examining the (sexual) relations between man and woman, Irigaray rejects the notion of woman’s Otherness being restricted to that which is analogous (and directly applicable) to the man:
the clitoris is conceived as a little penis…, and the vagina is valued for the ‘lodging” it offers the male organ…In these terms, woman’s erogenous zones never amount to anything but a clitoris-sex that is not comparable to the noble phallic organ, or a whole-envelope that serves to sheathe and massage the penis in intercourse… (1977: 23).
Interpreted metaphorically, Irigaray rails against the masculine appropriation of the female body/the feminine, or even the dictation of what should be under consideration for inclusion in this category. She maintains that woman (as the Other) is not fully represented, nor can she ever be, in such a pervasively phallogocentric symbolic economy: woman, consisting of only what is symbolically useful for the definition of man, can only ever be(come) a reflection (and thus an appropriation) of the masculine (Butler 1990: 16).
What Irigaray believes is the true femininity is an indefinable infinity of identity, an “epanding universe to which no limits could be fixed and would not be incoherence nonetheless” (1977: 31). This ideal of unbounded identity, which is such anathema to the Other, becomes Irigaray’s construction of the Not-Me: everything which is external to the Subject becomes possible, and thus the Subject (the One) is defined by these infinite relations, becoming the infinitely situated subject. The Not-Me, then, is analogous in its effects to Weeks’s “radical pluralism” (quoted in Bersani 1987: 218) and Butler’s “deconstruction of identity” (1990: 189), in that by destabilizing the essential core of subjecthood, by refusing the Subject its concrete reference, it presents the possibility of a liberation from a rigid “identity politics” which, by necessarily perpetuating the categories of difference around “identity groups”, can only go so far in advancing an equal (because separate can never be equal) multicultural (or –sexual or –ethnic or –national) society.
Stepping back towards Irigaray’s text, I emphasize that this is not her explicit aim, but rather her ideal extrapolated by later (poststructural) theorists. Irigaray, unlike
“Foucault in the Streets”? Not Quite
Though Beauvoir and Irigaray disagree on the nature (or implications) of feminine alterity, both writers assume the need for a dramatic re-equalizing of a society, through the assertion of women’s One-ness (or Subject-hood) alongside that of men’s, thus eliminating the unequal binary of sexual division. They in turn lament the lack of a coherent feminine political identity, citing instead women’s primary allegiance to class, race or religion above gender (Beauvoir 1949: 19-21; Irigaray 1977: 32), foreshadowing (at least in the case of Beauvoir writing at the end of World War II, though less Irigaray) the rise of identity politics, particularly the feminist movement, and particularly (for the sake of this essay and this segue) feminist and other subaltern (gay, especially) mobilizations around AIDS. Relying heavily on the accounts of Treichler (1999) and Stoller (1998), along with others (Bordowitz 2004; Crimp 1987; etc.), I will attempt to interrogate critically the formation of identity around genders and sexualities in response to the AIDS crisis, and their expression (or lack thereof) in the policies of both the state and of AIDS service organizations themselves.
From the first institutional reports on AIDS, seemingly due to an accident of history, women were excluded from the “risk groups”: AIDS as a clinical manifestation was simply first noticed in the male homosexual population, and was certainly most strongly expressed in that population in the first years of the epidemic. Early accounts, and even contemporary accounts (stemming mainly from Africa as North America is now seen as “post-crisis” and thus beyond research) generally position women in an inferior role, being mentioned only in the context of their relationship to men: partners of IV drug users, partners of bisexual men, mothers of infected infants, prostitutes (Farmer 1996; Stoller 1998; Treichler 1999). Treichler notes that even though women were supposedly “represented” on the earliest versions of the AIDS research agenda, they were “summarily bounced” from the list when their contact with men was not conclusively shown to be the mode of their infection (Treichler 1999: 53). Later, as it became apparent that male-to-female and female-to-male transmission was taking place (or more generally, that women were indeed being infected with HIV), circuitous theories were circulated as to why these women were not “normal” and thus were not “women”: they abused drugs, they received fertility treatments, they were from the Third World (Treichler 1999: 61-5). Women as an unmarked category continued their noted absence in the increasingly complex risk categories of the CDC reports.
Beyond soothing
were explicitly justified by arguing that HIV incidence in women provided a general index to the heterosexual spread of the virus and that the purpose of identifying women at risk and preventing ‘primary’ infection in them was to prevent cases of AIDS/HIV in their partners and children. Again, there was no intrinsic concern for women as women (Treichler 1999: 63).
In an interesting parallel to Irigaray’s Not-Me construction, women simply do not exist as such in the early years of the epidemic (and it is arguable about whether or not they exist today). They reflect men’s actions (by being defined by who fucked them or by being made pregnant), or else serve as markers of what can and can not be accepted into the norm (yes: heterosexuality; no: drug use, prostitution, association with non-heterosexual men, poverty; the jury’s still out: lesbianism). Either way, women provide the boundary, defining the Subject by being defined as the Other. Women who (and the parts of women’s lives which) simply have nothing to do with masculine agency are made to disappear, allowing them to serve as transparent boxes in which HIV is put in and pulled out with no interference from the box itself[2].
Reactions to this framing of the disease by the biomedical “experts” varied greatly, but generally women were sidelined in the activist response. ACT-UP, the most well-known of the activist groups, was essentially an outgrowth (or a response to the lack of effect) of Gay Men’s Health Crisis of New York City. Though not explicitly defined around a “gay” movement, the majority of members and “actions” were directly associated with a gay, middle-class, white male lifestyle. Women and racial minorities (not to mention drug users, and the poor) were poorly represented in advocacy efforts, being relegated to the marginal, the marked, the “special cases”. Interestingly, a movement which has explicitly mobilized around a minority identity in turn defines itself by its difference, not only from the norm, but also from other minority identities: “In these ACT-UP materials [produced for “actions”], we receive a complementary message that African Americans, Latinos, women, and the poor have less intrinsic value, as seen by the quality and quantity of materials and campaigns devoted to their concerns” (Stoller 1998: 131). Rather than the monolithic Other against which man is defined, woman had become another other in a list of others against which ACT-UP defined its agenda.
Conclusion
[1] Some terminology: throughout the remainder of this essay, “Other” will refer to the bounded notion of alterity as described above, while “Not-Me” will refer to the more infinite notion, encompassing all that is external to the self. “Alterity” (and the associated adjective, “subaltern”) will be used to describe the condition more generally, to the avoid confusion that might occur when using the term “otherness”.
[2] An interesting and very literal demonstration of this is the “dipping” hypothesis explaining the infection of American military personnel in
Bibliography
Beauvoir, Simone de (1949). The Second Sex. London: Vintage.
Bersani, Leo (1987). "Is the Rectum a Grave?" October 43(Winter): 197-222.
Butler, Judith (1990). Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge.
Farmer, Paul, M. Connors and J. Simmons, Ed. (1996). Women, poverty and AIDS: sex, drugs and structural violence. Monroe: Common Courage Press.
Irigaray, Luce (1977). This Sex Which Is Not One. Ithaca: Cornell University Press.
Stoller, Nancy E. (1998). Lessons From the Damned: Queers, Whores, and Junkies Respond to AIDS. New York: Routledge.
Treichler, Paula A. (1999). How to Have Theory in an Epidemic: Cultural Chronicles of AIDS. Durham: Duke University Press.
Shoddy Construction: Development Discourse and Chagas Disease in Southern Bolivia
Chagas disease, a parasitic infection of the blood and internal organs endemic to the
Doctors without Borders (Médecins sans frontiéres, MSF) is a large international non-governmental organization (NGO) which defines its mission as twofold: providing necessary medical relief for underserved populations, especially in poor or war-torn areas; and advocacy on behalf of those populations served, both on the national and international stages.
In the department of Tarija, in southern
This dual role for MSF presents an interesting opportunity for analysis, in which the “gaze” (as defined by Foucault in The Birth of the Clinic) consciously represents itself as the speaking subject, “I”. This involvement/detachment, inherent in the ambiguous position of the advocate as both observer and participant, provides the perfect opportunity for the observation of the “god-trick” as described by Haraway (and though certainly noted, the contradiction inherent in the observation and analysis of the “god-trick” risks unrestrained recursivity and is anyways certainly not within the scope of this paper).
MSF paradoxically presents itself as both the provider of “healthcare” and “development” (as understood within a decidedly Western context) and the voice of those who require its assistance, who are presumed unable to speak for themselves (or even completely voiceless). Within the framework of postmodern (or post-developmental) analysis, this seemingly contradictory stance serves to both preserve and mask the rigid power relations inherent in the positions of developer/developee (or, more specifically in this case, doctor/patient) and advocate/one-who-requires-advocacy. The advocacy both raises awareness of the problem and underlines the need (of representation) of the population, thus justifying its own existence. Meanwhile, this advocacy further justifies continued intervention, which, especially under a Foucauldian lens, serves to create the population to be “developed” as a discrete organism and subject of study. The constant reports, censuses and studies undertaken as the “baseline”, status reports and final achievements of the development project are incredibly self-justifying, constantly promoting the extension and deepening of intervention, all the while selecting, filtering and channeling the flow of subaltern voices and narratives, lending “authenticity” to the dominant narrative presented by the advocates themselves. This uninterrupted flow of information and further involvement preserves the hegemony of the “norm”, the “developed” and the “healthy”, defining its “target population”, inscribing its own boundaries and barriers around this population while pathologizing the living conditions of rural Latin Americans.
This self-evident definition of those in poor countries as “in need” preemptively blocks off any policy options other than those which can be seen as “top-down”. This limitation is in the best case a self-perpetuation of development discourse which is out of control (because it is out of view) of even the most powerful actors (in the view of Ferguson), or, in the worst case, a systematic and systemic perpetuation of current, unequal North-South power relations.
My note
In an effort to improve clarity and to elucidate the specificity of this paper, I pause here to clarify a few things. First, a note on the region studied: Tarija is the southernmost and geographically smallest of
This seemingly haphazard selection of sites is due to geographic similarities (the areas studied occupy a “middle ground” in Bolivia, neither highland nor lowland, ranging from approximately 1,000 to 3,500 meters above sea level, creating an environment in which Chagas disease is highly endemic), organizational peculiarities of the NGOs themselves (MSF is only active in O’Connor province, CARE restricts its activities mainly to the municipalities of Entre Ríos, Uriondo and Yunchará, and Esperanza/Bolivia operates in Iscayachi in Tarija and in San Lucas in Chuquisaca) and due to my own experiences in the area. During three months in 2006 I worked as an assistant to CARE’s Child and Maternal Health program (Salud Materna e Infantil, SMI), which is itself under the Sustainable Food Security (Seguridad Alimentaria Sostenible, SEAS) project, working primarily in the municipality of Uriondo, but also travelling with CARE to Narvaez (in Entre Ríos) and Yunchará and with Esperanza/Bolivia to Entre Ríos, Iscayachi and San Lucas, where I met with public health officials involved in their Chagas control programs. Being involved in work with CARE and Esperanza/Bolivia (as a translator/assistant to a visiting director), I did not make a systematic study of the region or the projects, though in making this paper I have referred back frequently to my own notes and photographs from the time, as well as doing research from the websites and publications of the NGOs themselves.
In constructing the arguments presented below, I frequently refer to different projects by different organizations as “essentially the same”, leaving the details of the differences between projects and organizational structures essentially unexamined. Beyond academic laziness, this is due to practical and theoretical concerns. First, it would be impractical for research of this level to concentrate on one organization, as including more NGOs, while obscuring details, provides a more complete view of development in and around Tarija. The essential similarity I intend to study is the discourse emanating from these organizations to the population, depicting this population as, variously, “in need”, “under-developed” and “diseased”. Furthermore, the uniqueness of MSF’s explicit attempt at advocacy, though not necessarily their on-the-ground programs, provides and interesting facet for analysis of this kind, which will be compared with the discourse surrounding their Chagas control programs and the programs of other NGOs.
Finally, I leave the interaction between the communities and the NGOs only half-understood, creating a facile binary between developers and developees, ignoring the re-depiction of development discourse within and between communities and implicitly assuming a uniform response to and return on a given development project, which is emphatically not the case.
I want it to be clear that in writing this paper I am not condemning wholesale the projects under study or the organizations cited, and I am certainly not ascribing to them motives other than those expressed by the organizations themselves. Having lived and worked with people representing these organizations, I know that they work with the best intentions and with a common goal of eliminating poverty and increasing health, in the broadest sense of the word. I have never witnessed anyone working for any of these organizations treating the people of the rural communities mentioned with anything but the utmost respect and dignity. I do, however, believe that the fundamental beliefs and assumptions of these organizations in many ways perpetuate the inequalities that are so universally denounced. In writing this paper, I hope to illuminate a few of the processes by which these unequal power structures are reproduced.
Theoretical groundings
Critical development theory, which will be referenced (often indirectly) throughout this study, has emerged through the interaction of a number of ideologically distinct movements. Until the early 1990’s, studies of development could generally be divided into two strands (Ferguson 1994): those who studied (and supported) development with an eye towards fixing its shortcomings (Hirschmann 1967, Robertson 1984, etc.) and those (often identified or self-identified as neo-Marxists or dependency theorists) who saw the development project as a continuation of colonialism and essentially a tool at the disposal of Western elites to continue their control over large swathes of the “Third World” (Escobar 1995 is an excellent later example of this school of thought). Later theorists (such as
The term “development” itself is problematic, implying a natural and unyielding progression from the “un(der)developed” to the “developed” (Esteva 1992: 7). This binary between “developed” and “undeveloped” in many way mirrors the colonial (and neocolonial) discourses, framing an Other which is inherently marked (or particular) (see Haraway 1991) and inferior (see Said 1978). Further post-colonial (though not necessarily post-development-al) critics point out the problems of representation/re-presentation of the always-already known and marked colonial/feminine/subaltern Other in Western colonial discourse, implicitly drawing parallels to present-day attempts at advocacy and intervention (Spivak 1988). The common thread of this argument is that
knowledge [so as to better help/serve the ‘less fortunate’ Other] is always imbricated with power, so that getting to know (or ‘discursively framing’) the Third World is also about getting to discipline and monitor it, to have a more manageable Other; and helping the subaltern is often a reaffirmation of the social Darwinism implicit in ‘development’, in which ‘help’ is framed as ‘the burden of the fitest’ (Kapoor 2004: 632).
Spivak further criticizes the “worlding” which discursively separates the “
Other critics of the development project have constructed their analysis around causes and effects, attempting to understand the discursive and institutional mechanisms that seemingly doom humanitarian intervention to ultimate failure. Ferguson (1994) sees the ultimate depoliticization and bureaucratization of development projects in Lesotho as a side effect (which ultimately overshadows the intended effect) of institutional policies and structures which privilege the production of “expert” knowledge and the re-production of development discourse over the eradication of the conditions which necessitate their existence. The branding of “development” as a “technical problem” in this sense (how to maximize the effectiveness of the current policies and strategies) prevents aid agencies from addressing the fundamental discursive and politico-economic practices which result in inequality.
Still others draw more directly on the work of Foucault in explaining development as a problem of “normalization” and “apparatus (dispositif)” (Brigg 2002: 421). Brigg draws heavily on the governmentality literature in explaining the use of knowledge as power (see Kapoor, above), as opposed to relying on facile references to the “colonization metaphor”, seeing the operation of power through development as much more diffuse and complex than can be understood when “some post-development writers…overly aggregate the operation of power, to ascribe intentionality to a singular historical force such as ‘the Americans’” (433).
These theoretical points of departure will inform my study of the production of representative economies in the discourse of development agencies in southern
What they mean when they say “neoliberalism” in
Jeffrey Sachs chronicles in his book
All of this it not to say that these re-forms have made
Naming names and making space; or: Is it better to give than to receive?
Rural highland
What does it mean to know a community by the NGO projects in operation there? First, we must see who is doing the naming. It is the NGOs, of course, who erect these signs, though certainly with the participation (and most likely the labor) of the communities themselves. A sign is erected once a certain level of participation (which usually involves regular meetings, the designation of community representatives, and some material donations) is achieved, designating that a convenio (agreement) has been reached, enumerating precisely the shortcomings in the development of the community and stipulating certain responsibilities for both the NGO and the community. The sign then is a physical symbol of the contract, which, while constructed through the cooperation of two parties, leaves little doubt about the roles of the participants. While the NGO has clearly donated the bricks, mortar and paint, the community contributes labor, both in the actual construction of the sign and in the more intangible agreement to work with the NGO, and, in a sense, for the NGO. The symbolic roles of developer/developee (material-and-direction/labor), giver/receiver (active/passive) are reinforced, defining the communities not only by their needs (as is written in neat block letters on the sign), but also by others’ responses to their needs. In other words, these communities are only known and named by and through the agency of those outside actors, reinforcing the boundary between who is being served (and I intentionally use the passive voice here) and who is doing the serving.
All of this is not to say that CARE (for example) is being dishonest when it speaks of the desire for dialogue between community members and CARE representatives. CARE fieldworkers are in constant dialogue with the people of their assigned communities about the problems faced and possible solutions, and CARE investigations rely heavily on dialogue and participation in evaluating past projects and proposing new ones. These predetermined roles do, however, limit both the range of topics discussed and the possible solutions expressed. Ultimately, projects are conceived and incentives are decided upon in the offices in the cities, limiting the actual discussion at the monthly meetings to a negotiation of the timeline, the methods of evaluation, and, more basically, whether or not the proposed recipients of the aid will accept.
I discuss these signs by way of synecdoche, as one manifestation of the identities ascribed to and by aid organizations and communities in the region. Rural communities, the self-apparent primary units for developmental intervention, are named and described by the NGOs, studied under the rubric of development to discover the faults that require attention. In defining their units of study, aid organizations shield their own organization, their unique cultural practices and more generally their own specificity from the analytical gaze. As in Foucault’s account of the production of biomedical knowledge (Foucault 1963), developmental knowledge cannot be questioned because its origin is obscured, said to stem from the impartial analysis of the “undeveloped” themselves, while the processes and practices of those producing the knowledge are themselves presumed universal. The “undeveloped” are the specific and partial Others, while the developers remain the universal Norm. Thus the “target population” (which will be referred to without quotes throughout the remainder of this essay) is constituted as both external to the idea of a homogeneous “developed” world and as a necessary object of study, analysis and intervention for this unmarked development project, which can then assume the mantle of flowing naturally from a self-evident “need” towards an equally natural and universally desirable “development”.
Advocating for the Others
This binary division, and all that it implies (powerful/powerless, active/passive, giver/receiver, etc.), is fundamental to the concept of advocacy. In implying the powerlessness of those on whose behalf it speaks, MSF structures the discursive options available in its crusade, unintentionally (one would assume) reinforcing the powerlessness of its beneficiaries by portraying them as needy and thus unable to participate with full agency in their own “development”. MSF’s advocacy campaign in this case has taken the form of a photographic exhibition which has toured within
While MSF is the only one of the four NGOs under study which has attempted to advocate on behalf of those who suffer specifically from Chagas disease, every organization has used advertisements and media campaigns, hoping to raise funds by raising awareness. Plan International (and subsidiary organizations Plan USA and Plan Bolivia) uses language specifically relating to the participation of the communities in which they work, aiming to “enable[e] deprived children, their families, and their communities to meet their basic needs and to increase their ability to participate in and benefit from their societies” (Plan International: “Plan Bolivia”), while “help[ing] communities develop, grow and, ultimately, support themselves” (Plan USAa). Their rhetoric is distinctly hands-off, though reading through their programs, especially the Chagas control program, PROPLAN (Plan USAb), it becomes apparent that the locally-led approach is meant to apply more directly to the funding aspects, where the programmatic side of the project is centrally determined, with the implication that they are merely enacting the only logical course of action: “The Chagas Disease Control Program (PROPLAN) is based on the experiences of Plan Bolivia and Pro Habitat” comes as the only explanation of the development of the program itself, while this methodology is justified by the fact that “the funding has evolved from being almost completely externally supported to being 75 per cent locally funded[,] demonstrate[ing] that the program is on its way to sustainability and is highly regarded by the communities” (Plan USAb). Furthermore, while it ascribes 75% of the $11m of funding to “local” sources, $4.5m is provided by the central Bolivian government through the Vice Ministry for Urban Development and Housing (Viceministro para Desarrollo Urbano y Viviendas, VMDUV) and a further $400,000 to the Bolivian NGO Pro Habitat, totaling $4.9m (or nearly 45% of the total). Of the remaining 30% of funds, 92% is donated by the communities themselves by “provid[ing] local materials and labor valued at over $3.2m” (emphasis mine), meaning everyone is employed in improving their own houses and carrying the cane and stones necessary for this task, but implicitly excluding the communities from a “modern” cash economy on the basis of their poverty or being “undeveloped”.
CARE’s publicity campaigns (which, like MSF’s, are explicitly termed “international advocacy”) have centered more directly on subaltern empowerment, especially empowering women and girls to participate more fully in the decisions affecting their lives and thus improve their own lot in life (this mission itself being explicitly neo-liberal in its basic ideology, though that is a topic for another essay). In the “I am powerful” campaign, CARE
empowering women around the world to be catalysts for change in their communities…CARE tackles underlying causes of poverty so that people can become self-sufficient. Recognizing that women and children suffer disproportionately from poverty, CARE places special emphasis on working with women to create permanent social change. Women are at the heart of CARE's community-based efforts to improve basic education, prevent the spread of HIV, increase access to clean water and sanitation, expand economic opportunity and protect natural resources” (CARE USAc).
The advertising campaign, consisting of women in various forms of “traditional” dress staring proudly into the camera, asserts the power of the women to positively affect their world (Fig. 11). This campaign, however, echoes clearly the same exoticizing tendencies of the MSF campaign described above. Of the roughly dozen women appearing in the flash presentation (CARE USAa), two are shown in Western dress, and again, both are wearing clothes clearly identifying them as working directly for CARE. Apparently CARE’s work is to rescue women from the “traditional backwardness” holding them back, and only through CARE can they become “modern” and thus empowered. Through this approach, one can clearly see that
[e]mpowerment, with all its emphasis on strengthening the capacity of the individual to play the role of actor in his or her own life, has come to encompass a range of interventions to transmit, under tutelage, certain professionally ratified mental, ethical and practical techniques for active self-management. Under the sign of empowerment, one thus can observe the re-deployment of the whole panoply of psychological technologies for reforming conduct in relation to particular norms, from individual psychotherapy in various rational and cognitive forms, through the use of programmed behavioural techniques to group work (Rose 1996a: 348)
Though Rose speaks of “empowerment” more in terms of back-to-work programs or psychological help for inmates, important similarities can be seen with “empowerment” as a tool of international “development” and general social integration with the aim of lessening inequalities. Here, empowerment acts as a disciplinary tool, integrating these women into a cash economy and promoting “universal” (neo-liberal) ideals of human rights. These women and their societies are clearly measured against a yardstick reflecting Euro-American priorities and ideas of “progress”.
Esperanza/Bolivia’s discourse (as shown by the discourse of their parent/principal donor organization, Esperança, Inc.) is by far the least interested in meaningful participation in the conception and execution of the projects. In her column “Kelli’s Corner” in the November 2006 Esperança, Inc. newsletter, program director Kelli Donley writes of her first visit to Bolivia earlier in the year, describing an “intense, beautiful country” populated by people who are “sweet-natured and curious” living “simple lives as farmers and herders”. Donley clearly implies a nearly unbridgeable rift between her readers, American donors to Esperança, Inc., and the Bolivian population living in what is presumed to be a largely “traditional” society. In continuing, she states matter-of-factly: “parents know that indeed, because of the kindness of strangers, their children will grow to lead happy and healthy lives” (emphasis mine). Here, the agency of rural Bolivian parents in the positive development of their children is completely denied, as the absolute necessity of humanitarian aid (specifically, aid from the “developed” people of the
In analyzing their own publications, I hope that I have highlighted differences as well as similarities between MSF, Plan, CARE and Esperanza/Bolivia. While there is a great range in the amount of attention paid to community involvement and agency (with Plan, CARE and MSF all emphasizing the role of the community in their projects and Esperanza/Bolivia emphasizing the necessity for outside agency), I have shown that each organization’s approach is based on a fundamental, presupposed inequality and the “need” of the target population (which is in fact constructed by the very discourse which seeks to describe and analyze it) for assistance which is both externally mobilized and externally planned.
The sick house
In spite of their different formulations of the problems of (under)development, CARE, MSF, Plan and Esperanza/Bolivia all undertake remarkably similar[4] public health interventions in the rural communities in which they work. While CARE does not in fact provide Chagas treatment (though it does facilitate treatment at local clinics), the other three organizations all undertake regular diagnosis and treatment campaigns, coupled with the improvement of housing (mejoramiento de viviendas, MV) (Figures 12 and 13), cleanliness campaigns and the fumigation of houses and the immediately surrounding area (CARE does participate to a degree in these activities, especially the cleanliness campaigns).
Interventions such as these have a number of very distinctive ideological foundations. Fundamentally, they are based on a positivist, neo-liberal worldview, in which individuals (and those closest to them—families and communities) are taken to be the self-evident, logical and always-already existing units of the population, and thus are the preferred sites for intervention. From this ideological base stem the twin programs of biomedicine and development, with the realm of public health existing somewhere in-between. They both (or all three) depend on conceiving the world as essentially ranked and ordered, with individuals and communities (and bodies) moving smoothly along a continuum from undeveloped (sick) to fully developed (healthy). In this understanding, the categories of healthy and developed are taken to be natural and obvious while the categories of sick and undeveloped are seen as problematic and worthy of study to “see what is wrong with them”, or why they can’t just be as healthy and developed as the rest of us. This division creates a clear Norm/Other binary, leaving the Norm (developed, healthy) as both unexamined and unchallenged. In other words, in trying to understand why they aren’t more like us, we forget to ask why we aren’t more like them.
MV programs of the type employed by MSF, Plan, CARE and Esperanza/Bolivia rely on this uncontested construction of the Other in their conception. In exactly the same way which Foucault describes the construction of deviance as “unhealthy” or “pathological”, a Norm of housing standards (and those unhealthy or pathological conditions which fall below standards) is created and enforced in the cleanliness and MV campaigns. In these interventions, the place of rural communities as junior partners (if at all) in their own “development” is seemingly “proven” by what is interpreted as a previous lack of agency in improving their living conditions, thus necessitating assistance from external organizations.
The constant studies, censuses, meetings and investigations further cement the rural communities firmly in the realm of the object of knowledge, allowing development agencies to assume untroubled the role of subject (producer) of knowledge. As a subject, these NGOs remain uncontested because their existence is made to be beyond dispute, an uninteresting (because obvious) topic for study. Again, the subject/object dichotomy, mapped neatly onto the rift between Norm and Other, underscores the lack of agency of the rural communities themselves and overemphasizes the necessity for the agency of aid organizations.
Conclusion; or: what I didn’t mean to say
This is an excellent place in the paper to place this study in the context for which it was intended. It has been seen above that many of the programs, and especially the public representations of such programs, enacted by NGOs in southern
With a more prescriptive view, I do not believe that it is completely necessary or even possible to work “outside” of the power structures that create the actors involved. Assuming that one was working outside of power structures would require assuming absolutely impartiality of knowledge, an oxymoron if one were to believe in the cultural, partial production of knowledge. I write this essay as a means of properly situating the knowledge created by the programs and working through their partiality towards an end goal. The reproduction of power structures need not be an endless, repetitive and negative process. Even processes reproducing the subject/object or Norm/Other binaries as described above are able to achieve, in certain instances, what can be interpreted as a “good”: access to clean water, lower rates of Chagas infections and increased income. Further study placing the communities described into the category of primary agent will reveal that even subaltern communities retain a high level of agency, affecting not only their own immediate conditions, but also the conditions of a larger, national society.
This was not a study of Chagas disease, nor was it a study of developmental “intervention” per se, nor was it an explicitly political call for more Chagas research to find effective and safe treatments for this disease (though that would certainly be warranted—the current drugs are only safe to use with adolescents and are relatively ineffective). This is not to say that none of these would be legitimate topics for study, in my opinion, but that a deeper thread, the development organizations’ construction of their “target population”, runs through all these and must be considered. I have used Chagas disease as a convenient point of departure (from which it seems I have strayed), investigating instead the actions and rhetoric stemming from those committed to eliminating it from southern
[1] Ineffectively—Chagas’ disease is able to “hide” in the blood of adult hosts, and pharmaceutical treatments are considered prohibitively dangerous in patients under 6 years of age and above 15 years.
[2] I will continue to use the term “indigenous” throughout this section without quotes. I understand that the term cannot be used unproblematically due to its history in the service of colonialism, but I want to make the distinction that here I am using the term in the Bolivian context, in which “indigenous” has come to represent an explicitly political identity (though not necessarily a homogeneous one), and it is that invocation of a (possibly imaginary, but immensely powerful) political identity which I would like to convey.
[3] In this discussion I have noted the difference between the women of the photos and not the men. I have chosen to focus on only the women because I believe that the differences in dress are much more apparent to the uninitiated viewer, while the differences in masculine dress are much more nuanced.
[4] So similar, in fact, that I will not attempt to distinguish between the different outcomes of the different positions which have been detailed above. Plan, MSF and Esperanza/Bolivia are all involved in direct action against Chagas’ disease, with CARE involved more tangentially (it never refers to its programs as directly treating Chagas’ disease, but its cleanliness and home improvement campaigns all address issues directly related to vector control). Of the three directly involved, each one provides diagnosis and treatment for Chagas’ disease when and only when an effective program of vector control has been undertaken in the community, involving fumigation, the sealing of cracks in houses, the improvements of roofing materials and intensive monitoring of reinfestation by the vinchuca.
Figure 1. Municipalities under study in Tarija and Chuquisaca
Figure 2. Sign at the community of Antigal, Translation: Prefect of the department/Community: Antigal/Irrigation system – literacy (lit.: “literacization” or “causing to become literate”)/Benefiting families: 69/Agreement: DRIPAD (Desarrollo Rural Integrado y Participativo en Áreas Deprimidas, Integrated and Participative Rural Development in Deprived Areas) – community/Conserve the wild flora and fauna)
Figure 3. Photo showing the interior of a home before improvement (MSF)
Figure 4. Taking blood samples to test for Chagas disease (MSF)
Figure 5. Children being taught to identify the vinchuca, the vector for Chagas disease (MSF)
Figure 6. Fumigating a house (MSF)
Figure 7. Health workers teaching community members about Chagas disease (MSF)
Figure 8. MSF worker taking a blood sample during a treatment campaign (MSF)
Figure 9. MSF worker administering treatment to a child with Chagas disease (MSF)
Figure 10. Laboratory worker testing captured vinchucas for the Chagas parasite (MSF)
Figure 11. A sample image from CARE 
Figure 12. Interior improvement of housing
Figure 13. Exterior improvement of housing
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