The Gaze, Advocacy and the God-trick

Chagas’ disease, a parasitic infection of the blood and internal organs endemic to the Americas, plays a largely silent role in the lives of millions of rural people, from Argentina to the southwestern United States. Although present in the blood of up to 80% of the population in affected areas, and although this infection often leads to heart and intestinal failure, little attention is given to containing this plague outside of the rural communities themselves.

Doctors without Borders (or 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 Bolivia, these two narratives intersect. MSF (along with other NGOs, such as CARE, PLAN and Esperanza/Bolivia) is involved in an attempt to eradicate Chagas’ disease as a major cause of morbidity and mortality in the rural areas. This attempt generally consists of biomedical interventions in identification and treatment of cases (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) and pseudo-biomedical interventions (public health interventions) designed to improve housing conditions and thus prevent re-infection. In doing so, it involves itself in advocacy, which at least in this case has manifested itself mainly as “consciousness-raising” attempts, especially in the production of photographic expositions which have been shown in the major cities of Bolivia.

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 positions of both observer/advocate and interventionist/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 recusivity 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 –development) 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, in the best case is 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 perpetuation of current, unequal North-South power relations.

[for more info on this, check out:
www.msf.es --> click on "Especiales: Chagas: una tragedia silenciosa"
www.doctorswithoutborders.com --> click on "Country: Bolivia" or "Programs: Chagas"

or these books:
Escobar, A (1995) The Making and Unmaking of the Third World (Princeton, NJ: Princeton University Press).

Ferguson, J (1990) The Anti-politics Machine: ‘Development’, Depoliticisation and Bureaucratic Power in Lesotho (Cambridge: Cambridge University Press).

Haraway, Donna J. (1991) Simians, cyborgs and women: the reinvention of nature. (London: Free Association Books).]