post-scripted

GAVI Rorschach Test

2010-10-26T10:52:00.000-07:00

What's this logo represent?

a) we save africa and other blobby place

b) these blobby places might float off the planet without our help

c) both

d) neither

e) other: _______________________

If you can't, teach (or yammer on interminably on the internet)

2010-01-05T15:42:00.000-08:00

Probably no surprise to anyone who knows anything about starting an NGO (or any sort of corporation not-for-profit or for-), my (our) new project has stagnated, probably not to be revived. I still feel mostly convinced that it was based on a good idea, it was supposed to operate in communities that have a lot of potential and energy that could otherwise be wasted, and was addressing actual needs with programs that were highly appropriate to the context. If anyone out there has a few thousand dollars and a lot of organizing energy laying around, and wants to invest it in slum communities in India, please let me know. Thoughts about that organization, and the one before it that I left in the spring, still hurt—a lot—but I can mostly avoid thinking of them. Lucky me.

Me, I’ve mostly retreated from the whole “program” thing, into a world of research and theories and proposals. Doing social science (of the RCT variety) in one of the biggest cities in India, it’s a relief to mostly write grants, write surveys, clean data, run do-files, and still go out at night with a group of friends (who are not my co-workers). Might be less of a relief in the next months as I’m managing survey and fieldwork teams 7am-9pm, 7 days a week, but honestly, and I’m a terrible person to both my current and previous job for saying this, it’s really great to be doing something I don’t actually care about.

It’s not that I don’t care at all. Intellectually, I really couldn’t be that much more engaged (at least, without someone forcing me to read 400 pages of theory each week in addition to my other work). I work with people who are pretty much universally agreed to be the biggest geniuses/rockstars/“experts” in their field, all of my coworkers (who, blessedly, each have their own projects so there is no toe-stepping) are mini-geniuses destined for great things, and our regular meets and drinking are deliciously nerdy. My project is full of interesting challenges, and I’ve found out I really like writing surveys (or, at least the first draft. The 8th draft after two months and one day before the launch is a little less fun), asking interesting questions, teasing out relationships and pathways and connections.

I got a motorcycle. I have friends, a stable place to live, time to myself, plenty to do with friends and visitors, I live in one of the world’s great cities, and I even have some time to travel (and a salary which is below the poverty line, but way more than I really need to get by). I’m content, maybe even happy.

Probably time to move on. I’ve gotten my applications for grad school (MPH) done, and this year I’m promising myself not to freak out a month before school starts, and actually attend (yeah I’ve got and will have even more loans, but who doesn’t). I do fantasize about my job literally being to sit and read and think and talk and write all day, and I’m going to really enjoy this degree. I’ve even made tentative plans to get a PhD afterwards, and hopefully never again need to leave school, but we’ll see how much I like it in two years. No need to rush into these kinds of things.

I’m in a very different place than I was three years ago, but at least I’m still in the same field. I think I’ve made more than my share of mistakes for a 25-year-old (thank god I don’t have kids, or I probably would have seriously fucked up. better to get it out of my system now), but I’m figuring out where I’m happy, and where I’m useful. The world probably doesn’t need another American fieldworker drinking in hotels in tropical cities, but hopefully there’s some room for one more clueless academic.

defining needs ii: defining community

2009-12-28T15:07:00.000-08:00

yeah, so, started the "miniseries" a few months ago when i had an office job in dc and was getting pumped to go to grad school. then didn't go to grad school, got a job in delhi, and have been somewhat busy/distracted since.

but! the job involves a lot of academic research, into the effects of various types of voter education campaigns in slums in india's capital city, which while interesting in its own right, has me thinking a lot about defining community. chris blattman in a (quote in a) recent post touched on what i am going to say baldly: identities, whether individual or group, are created by exclusions. this is true whether you're defining your own (i am this because i am not that) or someone else (they are that because they are not this).

the logical analogy at this point would be to say that identity:individual :: community:group (roughly--i know it's not perfect). but the problem is that looking at even individual identity, one "identity" is actually composed of multiple overlapping identities--loose affiliations with different groups (language, gender, region, occupation, political, etc.) or one's relation to others (mother, loner, leader, etc.). individual identities always, by definition almost, relate a person to other people around him/her.

it would be great if you could extend that to the group/community level, saying everyone sharing one particular identity (language, for example) is a community. two problems with that are that first, it's hard to say who "shares" a specific (in this case linguistic) identity--do you need to speak it from birth, speak it fluently, speak it predominantly, speak it most comfortably, speak it in a certain way (even ignoring the blurry lines between different linguistic varieties); second, this identity is just one of many that the individuals in this group may have--they may be divided by religion, income, nationality, race, gender, education, occupation, etc.

the largest theoretical "problem" (for me) with community, though, is the exclusionary action of this definition. dominant groups (eg, white english-speaking males in the US) usually have the luxury of having their community defined at the most basic level of societal structure, allowing them to exist as the "unmarked" or the "norm", thus discursively becoming the only "neutral" observers, and in many ways becoming the ultimate arbiters of culture (and politics, etc). "ethnic" communities exist often in order to preserve or promote their community in the face of the normalisation of the dominant group, but in this way often cause their group to become, by definition, marked and subordinate (or think of the rite of "coming out" in the gay community, by which one marks oneself as "not-normal", with the assumed sexuality being heterosexual in the absence of such a process. but i digress).

so communities are problematic--but why are they useful, and how are they used? for me, in my work, they're useful because they are a way of segmenting the mass of "everyone in the world" into discrete, manageable groups, setting boundaries to my work or study. by defining one group as the "target population" (ignoring for the moment the way in which that designation is made), you can set boundaries to what you will and will not work on, and with whom you will and will not work. by naming one group as the target, you implicitly place another group or groups out of bounds.

usually, these groups are recognized (by me, the person who has really no business being there) by self-identification--if someone says they're one thing, they're that thing. this is really a great and not-great way to do things. on the plus side, at least you're not putting people in boxes that they wouldn't put themselves in (as long as you're not pressuring them to choose something when the distinction is meaningless to them--see the colonial history of nigeria (or a lot of the rest of africa) for examples of this).

on the negative, it takes a lot of time, and a lot of talking to people, and usually a lot of dead ends. i worked in pune for a couple years, in one slum, and with only two communities. in the end, i got to know pretty much everyone living within a couple of kilometers of there by sight, and got to know the boundaries between different self-identified groups there. but, i don't know the right word for these "groups" in marathi, hindi or even english. the point is, i couldn't go in there and simply ask "to which group do you belong in regards to x dimension?", but rather relied on knowledge passed to me from my colleagues and months of face-to-face discussions in homes, getting to know genealogies, accents, naming patterns and the historical memories of people. on top of that, there was never (ever) a clear and all-encompassing consensus on who was in one group and who was in another. sub-groups, groups that may or may not have been the same but broke off in the past, personal feelings, and the context of the conversation always affected answers, and couldn't really be taken into account.

for my job now, we're working on a "complete" descriptive accounting of the life of the urban poor in delhi (a city of between 12 and 15 million, depending on who and how you ask). this will take a lot of surveys, a lot of pseudo-ethnography, and eventually an identification of group "informants" to answer questions about the "community" as a whole. i've yet to wrap my head around a decent way to decide who is able to speak for a community, and apply that in 100 (at least) different areas of the city. defining a community is difficult enough, especially given that different overlapping communities may form for different purposes--linguistic communities of migrants living near one another, or a community of women who access services at the same community centre, or a community of men working at a cluster of mechanics shops, or a religious community comprised of persons speaking many different languages.

my colleagues have often said that this is going to be "fairly easy, if time consuming", that we can go into an area, generally ask around for the "leader", and once a consensus begins to emerge, interview that person. i'm afraid that that approach is going to leave out a lot of very interesting variation, especially if we prompt people by giving examples of leadership (in political affairs, for example).

at least that's a bridge to cross when we come to it.

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related posts:

defining needs i: defining poverty
Burn it to the Ground; or, Defining Needs: The Miniseries

Defining Needs I: Defining Poverty

2009-07-20T13:34:00.000-07:00

So the first definition that needs to be dealt with (and the one that started me on this trail) is "poverty" (which I'm taking to be the noun form of the adjective "poor", without significantly changing the meaning). So it's not entirely easy to explain my thought process as I fell asleep last night, but it started at this post over at Alanna Shaikh's Blood and Milk blog, specifically the last comment (as of this writing) about the "conundrum"--giving Knicks jerseys to kids at refugee camps can be exploitative and degrading, but so can telling "poverty tourists" (which, already, I'd put right up there with the Smithsonian's placement of an exhibit on "African culture" in the natural history museum) not to share food or even eat in front of residents during their tours. So, basically, distributing excess can be/is problematic as can be/is not distributing it (even though you're trying to avoid the first problem--and round and round we go).

Stepping back, you can see this is all based on a certain definition of poverty as a lack of resources (whoah that was a jump, but stay with me here). We (you know the "we", us rich, usually white, often male people who are almost invariably healthy citizens of countries in the global north) shy away from both of these issues because it makes us uncomfortable (or, maybe not uncomfortable enough) that we're forced to dehumanize other humans in order to address their needs (as we perceive them) for more resources--they lack things, we should therefore give them things, but that causes problems, and therefore we feel bad either way. Still with me?

So yeah, I think the "poverty is a lack of resources" or even "poverty is a lack of access to resources" definition is somewhat problematic. I generally prefer a definition (that I by the way did not come up with, but cannot for the life of me remember who did, so I can't be a good person and correctly cite this) that states "poverty is a lack of freedom". "Freedom?!" you say, "But, doesn't that mean youre some sort of crazy Bush-y neo-imperialist neo-con?!" My response there would have to be a polite "No, and I'm not even a libertarian".

So what's up with that? Basically, poverty often (always is such an ugly word) stems from a lack of freedoms--freedom to live somewhere in peace, and freedom to move in search of greener pastures; freedom to eat a healthy diet, or access basic (or even not-so-basic) medical care; freedom to send your kids to school, and to work in a dignified and economically-rewarding way; generally the freedom to live or die where, when and under those conditions as you see fit. Lack of freedom is both a symptom and a cause of what we call poverty, or I think it can be stated that lack of freedom begets more lack of freedom, in a self-perpetuating cycle, and in many ways can be seen to be synonymous with poverty. Handily, lack of resources is one (but certainly not the only) cause of poverty, which means yes, at least not all is lost with a lot of current development-think. However, other possible causes of poverty (via lack of freedom) are (in NO PARTICULAR ORDER):

Being a woman
Being not-white
Being born on the wrong side of an imaginary line
Speaking the wrong language
Believing the wrong creation myth
Juxtaposing your sexuality, external genitalia, manner of dress and/or manner of expression in a way that other find unappealing
Otherwise being defined as "not normal"
Et cetera, et cetera, et depressing cetera...

The best thing this definition gives us (again, us rich/white/healthy/male/northern folks) is that we now have a way of addressing poverty without eternally fretting over whether to give or not to give. Of course you assist financially where that's one of the limiting reagents in producing more freedom, but there are other things that need to be addressed as well, some individually, some locally, some nationally, and some globally. Of course, did you ever think this was going to be easy?

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Related Posts:

Introduction
Burn it to the Ground; or, Defining Needs: The Miniseries

Burn it to the Ground; or, Defining Needs: the miniseries

2009-07-20T13:19:00.000-07:00

So I need to write a series of posts about my own process (which I'm trying to go through again, right now) of defining the place of an international NGO in a poor community without defining said community as needy or said NGO as some god-like expert figure. Obviously, that process starts with a definition of the terms I just used ("community", "poor", "expert", "needs" and "place" are gonna be key words here, since I'm pretty OK with the standard definitions of international and NGO, or at least, OK enough that it's not going to come into play here).

The partial disclaimer to this is that I'm working with a start-up NGO that's based in the US and India (unfortunately, I'll bet you can already guess the dynamic there), and specifically thinking about one community in one slum in one city, and I've not decided yet whether I can name any or all of them--at the very least, please assume there's a lot more concrete thinking going on behind the scenes than you're going to see here. So, yeah, quick update about what's going on, and now it's time to actually think.

it's ok, just blog it out (health plan edition)

2009-06-27T17:40:00.001-07:00

having issues coming up with this program plan for a new ngo...hopefully writing some notes here (and eliciting comments?) will help me put my mind in order.

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in case you don't know me or know exactly what i've been up to, after working for about two years in pune, india, studying quite a bit of public health stuff (mostly independently) and reading too much, i'm working with a friend/former colleague to create an ngo in pune, bombay, kamshet (sorta...it's near lonavala, in the mountains halway from bombay to pune) and possibly eventually up in gujarat to work with members of criminal tribes (mostly the waghris, though expanding from there) who, for a number of specific historical circumstances, are extremely well excluded from pretty much any government assistance. not necessarily the poorest of the poorest of the poor, but definitely up there, and since we see this as primarily a case of lack of access, hopefully this can be worked out mostly in one generation.

so, in broad strokes the organization will be concentrated on education, health and community organizing (not necessarily in that order). education will be a serious bolstering of the education of kids attending govt schools (4+ hours of trilingual tutoring each day, pre-school, etc.), health is working out really basic stuff (childhood diseases, diabetes, pre-natal care, etc.) with a special concentration on tb and mdrtb (something i saw a disturbing increase of over the spring of 2009)--seriously working with the govt rntcp, identifying possibly resistant cases in the surrounding slum community, testing and treating with as little delay as possible. might end up opening a lab (or three) for this in the future depending on cost/benefit analysis, and definitely doing a lot of the DO half of DOTS, which the govt basically ignores. community organizing, though probably not the best or definitive term for this, will be concerned with supporting self-help groups, microfinance and getting legal documentation/representation for members of the community (caste certificates, ration cards, possibly unionizing to protect their employment from the slum "development" plans, etc.).

while i recognize it's kinda a dumb thing to open up a new "development" shop, especially in this economic climate (uh, or just in general), all of us working directly on it (one american, one brit, two indians from pune) have significant ties to the community which we hope to serve, speak the three languages which are most necessary (english, hindi and marathi, and we're working on gujarati), have good relationships with similar orgs in the general area (actually working to set up a health centre/program for an allied organization, hence the thing in kamshet), and generally recognize that this is a community which has specific needs (as they've enunciated them to us) which aren't being met by anyone in the area. so...yeah, there's my little defensive paragraph.

me personally, i'm going to be bouncing back and forth from washington to london to pune/bombay the first year, attending grad school in london, fundraising like a madman in the us and developing plans with local staff/community members to be implemented in my absence (in the areas we know best, namely pune), and then work on expansion to bombay upon moving somewhat permanently to india july 2010.

so there's that, now what will this health program be?

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first order of business in health is to deal with primary care, specifically for kids and pregnant women, in an organized and systematic way. best way to do that would be to work through community health workers (CHWs) who could help them access mostly the government services that would be needed--pre-natal care, reminding about vaccination schedules, going with them to different hospitals/ngo offices to get services, and advocating on their behalf to doctors (perhaps one of the biggest barriers to healthcare in the area, ugh). they would be caseworkers, service coordinators, instructors and very basic healthcare providers--giving first-aid, recognizing when more care is needed, and generally checking in on people as needed.

we'll have a part-time doctor at our centre(s) (in pune to start, expanding in 6 months-1 year to bombay, then 2-3 years up to gujarat, somewhat north of ahmedebad, but i cant remember the name of the town right now) who will provide somewhat specialized primary care (prescribing antibiotics only when needed, checking in with diabetics, etc) and medical guidance for CHWs and other staff (when something comes up that nobody recognizes, where to go for specialized care, etc.).

we'll start work on health education in the realm of nutrition--promoting good foods (drumstick, yeah), talking about equal food distribution within a family, talking about practices that should be minimized (tobacco use, lots of chai especially adolescents who are kinda nuts in this area, eating crappy food as opposed to eating cheaper, more nutritious food at home--this will also have a lot to do with women's groups/women's empowerment, and will work closely with the organizing program in this area), that kind of thing. to expand from there to substance use/abuse, sexual health (female AND male), community clean-up campaigns during the monsoon to combat malaria and diarrheal diseases, all that. a lot of that is going to be fairly indistinguishable from the community organizing programs, but that's kinda ok in my mind.

tb will be sorta a strange-looking outgrowth on all this community stuff, since it doesn't make sense fighting tb in one small (~400 people) community and ignoring the entire surrounding slum. so we'll be working with the local govt tb clinic, which blatantly doesnt do the DO part of DOTS at all, to do real proper follow-up of (all? just some? this is starting to sound too ambitious) tb patients in the area, hopefully preventing a lot of acquired resistance and fighting (on our own dime, unfortunately) primary resistance, since the govt blatantly denies its existence in the rntcp plan. that's going to mean a LOT of foot work, carried out primarily by specialized CHWs from around the slum, and lots of culture/sensitivity testing and sometimes providing a lot of expensive medicine.

the point of all the expansion is to work continuously with the waghri community across the main areas in which they live (they're semi-nomadic), so that treatment and education don't have to stop when they go to bombay or the village for two months. we'll have a lot of coordination between CHWs across all sites (who will most likely know each other anyways, since this is a very closely-related community), and managers at all centres, to ensure that nobody falls through the cracks like they have in the past.

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alright, that's my super-short description of the program in my mind, hopefully now i can write that in a more detailed and even somewhat professional way in the actual plan. i havent included any specific targets or evaluation rubrics, which definitely needs to happen. what else am i missing? what is just plain dumb? thanks for your help in advance.

What happens when you can't get your ideas straight

2009-01-10T05:14:00.000-08:00

So, it was recently brought to my attention that the philosophical foundation that I’ve based my health program on is not actually one, but two separate ideas. So now I’m all “Fuck, what do I do?”, and meanwhile we’ve got patients/clients/community members/partners (what do I call them? That’s a whole separate can of worms) who continue to place demands on us, and I’m not entirely sure of what I’m doing.

So, to start with, the idea that I thought my program was founded upon was the idea that health (including healthcare, medical treatment, health education and, broadly, life itself) is not a commodity to be bought and sold, but rather is a human right. Therefore, access to high quality healthcare should be universal and have no regard for income, class, language, race, etc. And in the beginning it was good, and it all seemed so simple.

But then I found myself writing project descriptions—for grants, for the website, for newsletters, for individual donors. And I didn’t notice at the time, but I subtly shifted my writing and speech to the language of access. I wanted to increase access to medications, to medical treatment, to prevention programs, to concerned and genuinely compassionate doctors. Beyond generally believing that this was a good model, that this could significantly improve health outcomes, I think I did this as a way to water down my ideas about universal healthcare, as a way to make them palatable to donors and generally to the people whose support I need in order to reasonably (and by reasonably, I mean, “within my small organization’s budget”) make a difference in the lives of the people I work for.

Selling out, watering down my philosophy, I know. I’m not terribly proud that I would adjust something so basic as the reason that I do the work that I do so as to have more access to money, but hell, at least I’m honest about that.

Anyways, so, the thing is that generally these two ideas work fairly well together. The community we work for is marginalized, without access to health care, and in many ways shows a higher prevalence of a number of diseases because of this lack of access. Our record has generally shown that by increasing access to prompt healthcare, we’ve been able to (for example) reduce child mortality to zero (since mid-2007, where previously most women tell stories about at least one or two children dying) and successfully treat all new cases of tuberculosis, slowing the spread of the disease and decreasing the severity and length of morbidity. So far so good.

Our work has focused mainly on providing intensive follow-up, ensuring doctors and health institutions treat our patients respectfully and fairly, despite linguistic and socioeconomic markers which clearly label our patients as the migrant poor, and providing any necessary treatment. Notice, the first two go along with the “access” focus, while the last generally fits better with the “universal healthcare” aspect of my philosophy.

Where these ideas stop getting along is when we move to the borders of our target population, and begin working with the less poor, usually from other neighboring communities. Along these margins, access to healthcare is spotty, rather than completely absent. People will come to you with reports showing regular blood sugar testing over the past five years, with a few notable gaps, and ask for free testing and treatment for their diabetes.

There are two things you can do here. First, if you were strictly following the dogma that healthcare should be absolutely universal and free, regardless of ability or inability to pay, you would of course provide free testing and treatment. However, if you were looking at this from the perspective of providing universal access, you would see that these people already have some access, the way to ensure steadier access is to provide limited assistance, perhaps for testing or treatment, so that the family, with a reduced burden, will be able to consistently provide the rest.

So that’s what I did on Wednesday. Sounds eminently practical, and in an imperfect world of finite resources, where I work for a small NGO instead of running the world government, it’s probably the best I can do. I can’t, at the moment, handle another full-on diabetic patient (with testing, follow-up, home visits, doctor visits, and paperwork tracking prescriptions) and my organization’s modest budget will be quickly tapped out if we get in the business of giving free medicine to everyone who can in fact afford to buy it themselves. But it always feels shitty, turning someone away because they earn too much money.

I could now go on for a while about a few more things this brings to mind: first, whether we are, by giving medicine and healthcare away for free (but paying for it ourselves) are in fact making a firm stand about the universal necessity of free healthcare, or if we’re just buying into a system that we can’t see a way out of; second, whether, in the context of limited resources, if paying for a prescription of insulin, for example, should fall on the patient, if they are able to pay, or should always fall to the party better able to pay (in which case, it would almost always be the NGO); and finally, if it even makes sense to speak of the “context of limited resources” in a world where most infectious diseases and many chronic diseases would be easily managed by a relatively small redistribution of the world’s wealth—in which case, it might make more sense, then, to stop this “on the ground” work altogether and work only on the side of forcing or coercing a greater redistribution of resources.

But those are questions for another day. As always, I need to get back to the Sisyphean task of improving health, and making do with what we’ve got.

Doubts

2008-08-23T09:18:00.000-07:00

I'm not going to tell you how it is, I'm going to tell you how I want it to be. I'm not going to tell you that every time I assess “needs” in the slum, I may be extending and consolidating colonialism in my own little way. I’m going to tell you that my colleagues and I constantly strive to act in responsible and empowering ways, giving agency back to our “disadvantaged” and “marginalized” target population. I’m not going to tell you that every time I go out of the house, getting a rickshaw, getting a meal, getting a coke, getting a check-up, getting our kids into school, I rely on my white face, my blonde hair, my blue eyes, my first language, that I use all these things as convenient stand-ins, as proxies, as a quick reference that I don’t belong, but what’s more, that I should be privileged for my difference, that my striking not-belonging is not a handicap, no, it’s something to be striven for and it’s a shortcut to accessing one last reserve of colonial power. No, I’d rather tell you that I constantly chafe at this, that being shouted at in the street, that gathering stares as I walk to work, that having people touch me, look at me, ask me for a hand-out, that these minor inconveniences more than make up for all the other minor and major hardships I am spared for the accident of my birth as a white, relatively well-off, Anglophone American male.

I will be one of the first to tell you that, by offering our children the opportunity to go to college (and even high school) in the United States and Europe, we are offering them the infinite possibilities that should be accorded to every person as a human right. What I’ll omit, however, is that behind this push for education, for travel, for a “global perspective”, lies the nagging implication that Indian education and even languages, by virtue of their local-ness, their particularity and their provinciality, are inferior and to be avoided whenever possible.

I won’t tell you that I worry that I’m lazy and ineffective, that I’m undertrained, underprepared and generally come from too privileged a background to know and get done what needs to be done. I’ll tell you that I’m doing the best I can. I’ll make grand statements about the “lessons I’ve learned” that I need to worry about my own mental health, my own physical health, and my own family. I’ll tell you that public health is a field you learn on the ground, that classrooms only serve to separate you from what you’re really supposed to be working on. I’ll tell you that my trips across the globe are necessary, that they’re something I just have to do. I’ll tell you that the days off I take when I feel shitty, run-down or otherwise decide that I don’t want to leave the house are necessary for my own well-being, and that without my own health, how can I improve the health of those around me? I’ll conveniently leave out the fact that I’m lucky enough that my next meal doesn’t depend on what kind of business I got in the market that day, that trips across the world (twice a year!) are something that a vanishingly small proportion of the global population can aspire to, that my cold wouldn’t even register on the sickness scale of those with whom I work.

I won’t tell you that my job is as much about me as it is about anything else. I’ll leave out the fact that I feel like a failure if I’ve not achieved a life outside of my country of origin. I won’t tell you about that certain macho pride I get when I talk about the worms, the germs and the bucket baths I take every morning. And of course I’ll completely ignore the fact that, even after years of moving between South America, the United States, Europe and India, I still feel the draw of the “exotic” and wish I could travel to the Taj, the lakes of Kerala, the bathing ghats of Varanasi and the ridiculous glitziness of Bombay. Of course I’m a tourist in my own home, but that’s not something I’ll admit to readily.

Instead I’ll feign boredom when I tell you about the buffalo herds I duck through on the way to work. I’ll pretend that the festivals, feasts and processions that I don’t understand are pure everyday annoyance, just something that prevents me from completing my “very important work”. I’ll tell you that my reasons for traveling to India have nothing to do with all those Salman Rushdie, Arundhati Roy and Rohinton Mistry novels I read in high school, oh no, I go to India because I want to right the wrongs of that seemingly-limitless procession that has beaten a well-worn path northwest to southeast for unknown ages. I don’t go to gawk, to exploit, to “find myself”, to export or to feel superior to those around me. No, I go for a genuine desire to leave the world a bit better than I found it, I go out of solidarity and compassion, and above all I go for well-thought-out reasons. I think therefore I am different. I won’t tell you that I doubt my own reasons. I won’t tell you that much of the previous horde held similar ideals. I won’t tell you that I’m terrified to find out how my “good intentions” are being twisted, perverted into providing just a nicer shade of paint for the old pesky power dynamic.

Of course I worry out loud that I’m forgetting the lessons taught in my universities. I don’t remember as much comparative health, statistics or critical theory as I used to. There is a worry that I keep inside, however, that these things never meant anything, that they don’t go far enough, that they don’t see the whole problem, that they don’t strive hard enough for the right solutions. That they’re descriptive, and I need something prescriptive to give my life structure. That maybe I’ve learned the wrong things, and there’s no university in the world that teaches the skills I need for my self-appointed position.

I’m not going to tell you that I constantly second-guess my conversations, my education and my career choices. I’m going to tell you that this is the best job I’ve ever had. I’m not going to tell you how it is, because honestly, I’m not sure myself.

benefits for whom?

2008-02-08T13:48:00.001-08:00

that's a weak title. sorry.

anyways, a professor of mine, actually the first professor of mine that ever even mentioned that "development" might not be a universally positive force (and he did a lot more than mention it--that's what the entire class was about. imagine how eye-opening that was after learning for 3.5 years of university that development is awesome because it always helps the poor [fill in the blank]), said that the only thing that development can universally be shown to do is to produce more developers. or something along those lines. a mere two years later, i think i could list a couple more things that development (i'm gonna omit the scare quotes throughout this post and the rest of this blog from now on, but just imagine they're there) usually does (in my experience), but that's pretty tangential to what i'm on about right now.

what i'm on about is being produced as a developer.

so a lot of this can probably go under the heading of "pseudo-guilty whinings of an over-educated guy with too much time on his hands", so i might as well get that out of the way first. i'm currently going through the song-and-dance of getting a work visa so that i can get paid for the work i do in india. so there's that direct benefit: i get enough cash to pay for my cokes and a couple dinners out every month. which is cool, that i don't have to constantly watch my savings drop and drop. but i mean, that just underlines the first problem: the type of work i do (and, let's be honest, a lot of corporate jobs too) might as well have a minimum parental income as part of the job description, with all the free work (internships, volunteering, working hard at lots of random extracurriculars) that you need to do before you actually start getting paid.

i mean, its not to say that development is the exclusive domain of the upper end of the class scale, but in many ways it might as well be. i don't deny that there are a lot of great grassroots organizations out there (TASO is a great example of this), but the mere fact that you have to qualify it with "grassroots" tells you something: it's not the norm (and we all know about norms and power dynamics), and as the "marked" and "particular", grassroots organizations have a lot of trouble being taken seriously. anyways, the point is, i use my class and my parent's wealth to my advantage in order to "finance" my employment. the same is true of a lot of other fields of work (to get a job as a lawyer, and usually even to get into law school in the first place, you need to be interning a law firm for a few summers), and development is maybe even better than most, but also has the effect of preventing social mobility in the end.

so on top of that, above and beyond who gets the job, it often weirds me out just thinking about getting this job at all. i mean, who am i (and by extension, who is anyone) to get paid to dispense something that i fervently believe should be free to people to whom my salary would seem like a small fortune? i mean, maybe my money could be better spent hiring and training someone from the busti to do my job. whoever got hired would certainly have an easier time of it, and would probably/possibly bring a more "authentic" viewpoint to it, however you want to define that. but again, ignoring who gets the job, its strange to be essentially living off of other people's misfortunes. i'm not a collection agency or anything, but in theory i have a selfish financial incentive not to eliminate poverty and/or poor health outcomes, as i would then be obsolete. i think my motives are separate enough (enough) from pure profit motive that i would still work to eliminate poverty and/or poor health outcomes, and anyways there's very little danger of me personally working myself out of a job. which gets back around to the original statement of my professor, my work isn't necessarily good at "developing" people (or improving health outcomes or anything on a large scale) but really about producing myself and the people with whom i work as the developer and the developees: they are created in an image (that they wouldn't necessarily have been created in had i not ever landed in india) that sets them in a very particular place in a number of global power dynamics.

so that's been a lot of fairly negative posts lately. in the next few posts, i really hope to put forth a few of our proposals, a bit of what we're doing, as a positive alternative to normal "development". i'll do my best to stay fairly critical (in the theoretical sense) of our actions, but i think it is necessary to make proposals rather than just critiquing existing programs/past/future actions if you're working in any sort of applied setting. so: stay tuned!

my life as a dinosaur

2008-01-27T08:57:00.000-08:00

please click to read it larger, i promise it's worth it. here's the transcript if you're lazy:

T-Rex: So this homeless guy asked me for change yesterday.
T-Rex: The first thing I thought was "Sure!".
T-Rex: But THEN I thought well, wait, if I really want to fight homelessness wouldn't this money be better spent on community programs that fight it, both through helping the homeless and through political change? But then I thought, well, this guy's right here, you know, and saying I'm gonna to make a donation isn't gonna cut it. And then I thought, wait, this guy looks pretty out of it - is he going to spend my money on drugs? Do I want to tacitly support addiction?
Dromiceiomimus: And then you thought how prejudiced that was?
T-Rex: Sure did!
T-Rex: Then I thought, even if he is going to spend it on drugs, is it my job to deny him money? Should I go around enforcing my morality on others? Then I thought, geez man, how ridiculous am I that a guy asking for change throws me into these throes of self-doubt and analysis?
Utahraptor: Pretty ridiculous?
T-Rex: Pretty ridiculous! But then I recalled Socrates' "the unexamined life is not worth living" and at that point my head pretty much exploded.
Dromiceiomimus: Did you give the guy anything?
T-Rex: I gave him all my change and whispered "DON'T TELL ANYONE UNTIL I CAN FIGURE US OUT"?

http://www.qwantz.com/archive/001109.html

quick gripe

2008-01-22T09:02:00.001-08:00

I realize that a big part of the reason I’m often unhappy with what I do is that, in many ways, my job is incredibly negative. Unfortunately, our project is at a stage where we’re (and by we, I mostly mean I, as I’m the only one working on health projects full-time) struggling to keep our (my) heads above water. We do what we can for the people we’ve already “taken” as patients, try to treat the most urgent needs of those we haven’t “taken”, and pretty much turn away the rest. So it’s become that at least half of my interactions with people in the centre and in the street are them asking me for things that I just don’t think I can do (or don’t want to deal with, or there’s not even a difference, I don’t know).

And there are basically two ways to look at that: either me turning them away isn’t really going to affect there health much, as they’ll just go pay for it themselves somewhere; or me turning them away is pretty much the end of the line, and they go back home and wait out (or don’t) whatever their malady is. Neither of those is particularly palatable, from my point of view. If the former is true, then my job isn’t really necessary, and I’m risking imperialism/perpetuating the current oppressive societal structures for no good reason. If it’s the latter, I’m no longer acting as an agent of change and have turned into just another health access point that is blocked. In which case, my job isn’t really necessary and I’m risking imperialism/perpetuating the current oppressive societal structures for no good reason.

It’s not like both of those are true all the time, and I’m sure often enough it’s not even that me turning them away is really going to negatively affect their health in any major way (it’s not like we normally give out basic pain medication or decongestants anyways). But I can’t always help the sneaking suspicion that every time I tell someone I’m too busy, or I don’t go up to their home because they missed a BSL, or I wait until they come to me for meds when I know they need a refill, I’m not quite doing the very thing that I explicitly came to do.

And fine. My excuses are in general legitimate. I’m stretched beyond thin, doing the majority of the health stuff on my own. I can’t just indiscriminately take everyone that comes in off the street, take them at their word for where they live, what their need is, how much of our time they need. If I did that, AIC would be broke and I would be crazy. But there’s the nagging thought that I could do more, I could rest less, I don’t need a day off every week. Still...

Still, where does the line come where I’m just another barrier to healthcare? I mean, fine, there’s a fair amount of “maybe if I’m super inefficient then you’ll just give up and go away” in the bureaucracy in pretty much every institution we’ve dealt with here, but in general, I think people are doing the best work they can under the circumstances.

It comes down to the fact that in a lot of ways I identify a lot more closely with people working at the hospitals that with the people I take to the hospital.

no, really, abortion does affect your daily life

2008-01-22T08:28:00.000-08:00

i sit reading (and now writing about) Said's Orientalism in this coffee shop, mocha, in pune, india. i realize the irony here (or maybe that's an alanis morisette definition, i honestly don't remember anymore): this cafe is ostensibly a hookah bar, and the menu is full of fun things like the word "sheesha" written to look like ةاي ققاي, some crazy take on arabic. and, of course, the fact that i'm probably, in some way, engaging in orientalism myself by just being here, categorizing, judging and working to improve the "other" (the poor, poor indians) by witnessing their ills, feeling moderately outraged, and helping them to use free services already in existence. andi've been struggling a lot (see my other posts) with both the quality of work i'm doing and the premise behind it. but that's neither here nor there. i'm here to Blog For Choice, apparently.

so obviously, abortion exists here in india. and not always in the good, "it's a woman's right to her body" kind of way, but a lot of time sin the "it's my right as a man to have sons" kind of way. the at-birth sex ratio is something ridiculous like 1.2:1 males:females, and sex-linked abortions, though illegal (it's illegal to tell the sex of a fetus), are certainly not uncommon. so yeah, ilet's not pretend that even the right to end an unwanted pregnancy is always and necessarily an empowering thing for a woman. but don't worry, i don't think anyone was. so abortion is also sometimes a tool of the patriarchy. brilliant.

but i wanted to really write about how i see personal control of fertility (of which abortion is certainly a part) as necessarily empowering. india is, by many standards, a very conservative place (bla bla generalizing reducing essentializing ok fine). tubal ligation (TL) and abortion can only be done with the consent of both husband and wife (god only knows what would happen outside of marriage), though i suspect a vasectomy only requires one signature. sterilization is actually highly promoted around here, and there are some pretty good incentives in place (everything free at the hospital, and they hand you cash at the end). but dozens of women have approached s in the past month telling us that they want us to help them out with their TL's, rather than they doing it on their own.

well, generally government services aren't of the highest standard (though i do believe that in almost all cases they are completely acceptable at least). the sassoon general hospital is more akin to a bus station than an american hospital, honestly. but we've found this gem of a public hospital about 8km away (so transport is a bit of a hassle), but in general it's quiet, clean has a good patient to attendant ratio and is served by some of th e best doctors in the city. so we've been taking patients there, especially for gynaecological surgeries. it requires a lot of effort and time on our part (and a fair bit of money for rickshaws), but the women are generally quite happy with the lebvel of services they get there. so there's one barrier overcome, mostly: the goverment services near us ar crappy (and our patients haven't had good experiences there), but the good government services are too far away to be realistically accessible.

so the next barrier to free reproductive choice (and this is not in order of importance or in what order they affect people, just in the order that i happen to be writing) has in general been a pervasive and rigid patriarchy that prevents women from exvercising free agency over their reproductive system. though this varies pretty drastically and is expressed differently in the three communities in which we work, there's a definite pressure on women to produce a large number of children, male children in particular. we've got one woman who cried when she saw her fetus on the sonogram, because "it looks too big, they'll never take that out" (she already has three young boys). another woman is younger than me and has eight (!!!!!!!!) children, but her husband would "never agree to an operation [for her]". a third has three girls, had an abortion last year (you can guess why) and is constantly asking us to put her on fertility medications, as she hasn't had her period in months. the first's husband didn't agree to an abortion (there's still plenty of time), but said she can get a TL when she delivers. the second finally got her TL after her husband was to embarrassed to discuss the matter with us. the third has no known reason for her current amennorhea, so there's not even a discussion about what we're doing there.

so yeah, wtf. i hope that the three quick sketches above illustrate pretty well (without much commentary) why i'm pro-choice, in all matters. banning or unnecessarily restricting abortion (for any reason) is just another step into treating women as walking incubators/baby factories. women (and men, of course) should have complete control of what goes in and out of their bodies, and when. i don't care who helped put it there, or wants to see it once it's out, if it's in you or there is the prospect of it going into you, it's your choice, period.

half/half/half

2008-01-14T08:08:00.000-08:00

so i've been meaning to write something here, but i havent because i've been busy/irregularly inspired. which causes me to write half posts, and then leave them, and pick up something else a few weeks later. anyways, so i've decided to post a couple of half posts with maybe another half for a wrap up, to at least document my state of mind over the past few months (god has it already nearly been 5 months?). without further ado:

..........................................................................................................................
6/10/07: "i lasted an entire month, that's not bad"

"sometimes in the morning, i am petrified and can't move,
awake, but cannot open my eyes
...
but you'll smile, you'll make it through,
you'll fake it, if you have to"
-Rilo Kiley, A Better Son/Daughter

so i don't usually start this blog with an epigraph, like i sometimes do with the photo blog, because it seems, well, really cheesy. but i guess this one seemed to really fit my current mood, so i figured why the hell not. it's not like anyone is gonna notice except me.

so it's been exactly a month since arriving in india, and the wall must have come at some point in the past 72 hours. i guess i probably don't have much profound to say except to report what i did, since i haven't had time to think much less read for myself in the past month.

.......................................................................................................................

13/11/07: "what's eating me"

"sometimes in the morning, i am petrified and can't move,
awake, but cannot open my eyes
...
but you'll smile, you'll make it through,
you'll fake it, if you have to"
-Rilo Kiley, A Better Son/Daughter

so i was gonna use that epigraph for the beginning of a post about a month ago that i never got around to finishing, but then i never got around to finishing it, and anyways, it seems fitting again. which is depressing, but maybe i'll get to my own personal issues later on. right now i wanted to talk out (to myself, i suppose) some of the more philosophical issues i've been having with stuff as it's been going on here.

i guess i should start with the standard disclaimer i had for that piece about care, that this is more a criticism of the theoretical underpinnings of a project and not really about the execution, and certainly not about the beliefs and attitudes of those carrying it out. and i really want to add now that this isn't even so much a critique of the theoretical underpinnings of the project i'm working on, as much as me talking out via the internet the possible future problems with possible future projects, since most of the stuff i have the larger problems with still hasn't happened yet, and might not happen (and almost certainly won't happen in the forms i'm envisioning, since nothing ever does).

and a further caveat being that i'm academically severely out of shape, and my english is even beginning to suck.

and begin:

my first and biggest issue lately is with a possible feeding program that we're beginning. in the community we're working with (funny, even though i've forgotten most of what i've learned in the last year or two, i still instinctively cringe at the word "community". but i guess i might as well use it, since i can't remember clearly why i'm not supposed to), there are a number of elderly folks that for one reason or another completely lack any support. either they don't have kids around, or their kids don't support them, or their kids can't even support themselves. but generally, they're unable to work themselves, the don't receive outside help, and thus basically they don't eat. and thus basically they're slowly starving. so yeah, severe malnutrition in a vulnerable and generally necessarily dependent group. it seems like a no-brainer i guess, but for some reason the

.................................................................................................................................

14/01/08: [cut back to the present]

so there i am. or was. fun little trip through my psyche, or whatever. now, in january, 4.5 months, nearly, since i arrived here to start my "job" im feeling a lot better about it. my hindi is at least passable, i'm finding a bit more agency/feeling a bit more empowered in my current role, and i may even start getting paid soon. basically a symbolic salary, but at least it will pay for my caffeine. and get me a work visa, which is a bit more secure than my current entry visa (which i'm not even supposed to have, making it especially fun to extend). the downside is i have to get back to the states to get that worked out, and before that, i need to get stuff worked out here. i'll be leaving my work for at least a month, assuming nothing goes even minorly wrong, and leaving hindi for the same period. which might be a bit scarier. because i'll come back and feel like i felt in early october, which was not a great place to be in, mentally.

anyways, i've been feeling guilty about my work lately. it used to be, especially in the beginning, work from sun up to almost sun up again. lately, ive put in my 8-10 hours a day, but in a spotty way. and much more of my work has been the administrative/managerial work that i just didn't have to do before. sorting out volunteer timetables/job descriptions, fighting tooth and nail for concessions at hospitals, making budgets and keeping track of our accounts, writing reports about what i've been doing. and yeah, i spend 3-4 hours every day working in the centre or the hospital or the slum, but it doesn't feel like enough. i feel like i have all this free time (like writing now on this bloody blog) and i'm not doing enough to expand our programs, or open them to more people. at least half my time sitting in the centre talking to people is taken up explaining to people that come in off the streets that no, we're not just going to take them to the hospital or the pharmacy right now, we're going to go about constructing our program in our own slow and methodical (or at least we tell ourselves) way.

so, here' s a checklist of things i want to do before i have to get the hell out of india in a month:

....... work out lesson plans for the month/month-and-a-half that i'll be gone for health education
....... get my february (and january, for that matter) cataract surgeries done, so that i can pick up march when i get back
....... get a bit of actual data/data sets going, so i can do some useful analysis while im away (as well as getting the gis data sets from shelter associates)
....... figure out a few points for easy government/free clinic medical access, to send people to in my absence

and stepping back, it looks like i'm incredibly bought into the idea of myself as indispensable. and i know that people are becoming too reliant on my/our agency and less on their own. or maybe they're not. i guess it really shouldn't be for me to say.

ugh, and now im getting ridiculously regressive in my thinking. not really helpful. but i've got excuses, at least. my dog is really sick and i get to give it little 2.5ml squirts in the mouth of egg whites and electrolytes every 30 minutes or so. and my computer's dying, meaning the power cord is now broken more often than not, therefore i may not accomplish any of the above tasks, ever. AND my visa is expiring in under a month and i still don't know if i'm even going to extend it or just head back to the states to get an entirely new one.

ok, so fuck coherence, im too fucking stressed. this post is officially over.

atlanta-based charities give american agribusiness the finger

2007-08-16T19:39:00.000-07:00

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?

2007-08-15T20:05:00.000-07:00

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!"

on "what the hell am i doing"?

2007-05-29T10:54:00.000-07:00

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":

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)

[from the CDC's "Self-study modules on tuberculosis. Page 8 of Module 1]

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

2007-05-16T07:31:00.000-07:00

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 United States and Africa, followed by some conclusions.

“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 Butler (and Foucault) does not deny the pre-discursive existence of the subject, only the Subject. Her depiction of the woman as Not-Me does not go so far as to deny the existence of the “feminine” or the “masculine” (in fact, it relies on their pre-discursive existence), only to problematize their current boundaries, or, in fact, that they are bounded at all. She concerns herself, rather, with “the rejection, the exclusion of a female imaginary [which] certainly puts woman in the position of experiencing herself only fragmentarily, in the little-structured margins of a dominant ideology, as waste, or excess, what is left of a mirror invested by the (masculine) ‘subject’ to reflect himself, to copy himself” (1977: 30). The implication of this notion of gender and sexuality as essential is for a dramatic broadening of the boundaries of the socially accepted criteria of gender and sexuality, allowing a full definition of “woman” (and thus “man”) according to her (or their) own, non-reflexive attributes, leaving again a divided field of sexuality; not erasing alterity, but shattering it into a multiplicity.

“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 America’s heteronormative psyche over the risk of HIV entering the “general” (white, middle class, perhaps even male) population (or the maternal womb, in the psychoanalytic sense), the exclusion of women clearly plays out Beauvoir’s and Irigraray’s understandings of alterity. Women (and other subaltern groups) are marked by their difference, discursively constituting them as a homogeneous group, while obscuring their relationship to (and the heterogeneity of) the dominant group. In portraying the woman as vector (in the case of the prostitute), woman as vessel (infecting her child) or woman as victim (as in the category of “heterosexual contact with other risk group”) (Treichler 1999), women were (and are) systematically denied agency (a thing usually reserved for a Subject) in the spread of the disease (and thus concern for their wellbeing): either women were infected by other “risk groups” or other “non-risk groups” were infected through them. The few studies that explored HIV transmission in women

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

Identity politics, unfortunately it seems, must always presuppose an identity. A gay movement must necessarily exclude the non-gay, a black movement must exclude the non-black, and even a women’s movement must exclude the non-women (and those for whom the identity of “gay”, “black” or “woman”, respectively, is not the primary site of allegiance), to say nothing of movements and ideologies based explicitly on the exclusion of Others (anti-Semitism, racism, sexism). In constituting, or even theorizing, a coherent identity we must assume that there exist those who do not share that identity, or else that identity loses its significance. With the assumption of the existence of Others, we seek to discover, describe and categorize their difference, their Otherness, but in so doing so we fail to fully represent them, using only the traits that mirror our own, excluding those which are of no “use” to us. The subaltern identities created by both the Norm and the reactions to it create valuable sites for the mobilization of resistance, but they are doomed by their very natures to perpetuate the discursive practices privileging certain differences over others, setting groups apart and necessarily creating power dynamics. While the “radical pluralism” envisioned by Weeks and others seems unlikely to come about (either of its own accord or through the actions of wo/men), it serves as a useful goal and furthermore can help to illustrate the mechanisms through which inequalities are perpetuated in society. Assuming the continued existence of “identity groups” as such, it must be recognized that these groups themselves are dependent upon and perpetuate the politics of difference in order to mark them. Social change (towards equality, but also away from it) can come about through the articulation of subaltern demands around these identity categories, but it is the construction of these categories which in and of itself ensures continued inequality.

[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 Germany (Treichler 1999: 61-2).

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

2007-05-16T06:56:00.000-07:00

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 northern Argentina to the southwestern United States. Although present in the blood of upwards of 50% of the population (Médicos sin fronteras) in affected areas, and although this infection often leads to cardiac and intestinal failure, this plague receives little attention outside of the rural communities themselves.

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 Bolivia, these two narratives intersect. MSF (along with other NGOs, such as CARE, Plan International 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[1] and pseudo-biomedical interventions (public health interventions) designed to improve housing conditions (by fumigating houses, plastering over thatched roofs and promoting household cleanliness) and thus prevent re-infection. In doing so, MSF 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 and inernationally.

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 Bolivia’s nine departments, bordered on the north by the departments of Potosí and Chuquisaca and on the south by Argentina (Figure 1). It occupies a curious middle ground between highland and lowland culture and especially between what is thought of as Andean-Bolivian and lowland-Argentine. Recent exploitation of natural gas reserves in the eastern, lowland part of the department known as the Chaco has brought unprecedented wealth and growth to the department, though the rural areas remain extremely poor and are disproportionately affected by acute diarrheic diseases, malnutrition and Chagas disease. The department is sub-divided into six provinces and the provinces are further sub-divided into eleven municipalities. Tarija is also the name of the capital city of the department, lying in the municipality of Cercado, between the highland municipalities of Yunchará and El Puente and the valley municipalities of San Lorenzo and Uriondo. The area under study, however (for reasons explained below), will consist of the areas within a few hours’ drive of the city of Tarija, from O’Connor province in the east to Yunchará and Iscayachi in the west, and will also include one municipality of the bordering department of Chuquisaca, San Lucas.

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 Ferguson 1994, though this school is explained further below) have applied insights from poststructural (discourse, especially) theory to the production and reproduction of unequal power relations, as generated by the development project itself.

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 “Third World” from the “West”, disavowing the complex relationships and histories of imperialism, co-optation and general continuous historical interaction (1988: 291).

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 Bolivia. I hope to show how the production of knowledge (and the assumption of knowledge) has led to the re-production of unequal power relations between developer and developee. However, before that study can commence, a short explanation of Bolivian politics (and how they are formed and informed by the governmentality and critical theory literature) is necessary.

What they mean when they say “neoliberalism” in Bolivia

Bolivia’s experience with neoliberalism (as both an ideological and a political-economic ideal) has been in many ways unique. Overwhelmingly, the term is used in reference to the economic policies of the 1980’s and -90’s, especially under the direction of Gonzalo Sánchez de Lozada, either as planning minister under Víctor Paz Estenssoro from 1985 to 1989 and as President from 1993 to 1997 and from 2002 to 2003. “Neoliberalism” has become a byword for structural adjustment programs, privatization of state-run industries and the entrance of multinational corporations into the Bolivian economy, as it has become a rallying cry for leftist political parties and movements. Bolivia’s unique history and experience with neoliberalism leaves the term nearly completely disconnected from the post-structural (ideological) meaning used by Rose and others, though important links remain.

Jeffrey Sachs chronicles in his book Bolivia’s first experience with the “shock therapies” to introduce the country to economic liberalization. Massive inflation (24,000%, the highest in the world in 40 years) in the early 1980’s due to government fuel subsidies coupled with a regional economic crisis and the collapse of mineral, especially tin, prices caused enormous destabilization of the economy, prompting the measures which rapidly removed all price controls on the Bolivian currency and subsidies on various products ranging from food to fuel and mineral resources. This initial program and those to come later, enacted under Sánchez de Lozada and others (Jaime Paz Zamora, Hugo Bánzer and Jorge Quiroga) included the liberalization of Bolivian markets, allowing extensive foreign investment in state-run industries, selling off such companies as the Bolivian Fiscal Petroleum Deposits (Yacimientos Petrolíferos Fiscales Bolivianos, YPFB), the state-run gas company, which was essentially dismantled under the reforms (which would provide a source of political discontent in the coming years). These policies, in the longer term, have had mixed results, allowing Bolivia a minimum of economic stability to grow generally through the 1990’s (Sachs et al 1988; Schroeder 2000), but also generally adding to the political instability while doing little to reduce poverty (especially among the poorest of the poor) or inequality (Crisp & Kelly 1999; Schroeder 2000).

All of this it not to say that these re-forms have made Bolivia a thoroughly neoliberal state, though significant strides have been made in that direction. Neoliberalism, as understood by Rose (1996a, 1996b) through the literature on governmentality (stemming from Foucault’s seminal lecture (Foucault 1991)), requires the re-conception and re-figuring of the individual as an active agent of their own government (meaning here personal behavior), seeking out those activities, behaviors and conditions which would most benefit them and, through the collective, become a “public” good. The Bolivian government has always had to contend with multiple, thoroughly overlapping identities among the people within its borders, representing workers’ groups (miners’ unions, coca-growers’ unions, teachers’ unions, etc.), ethnic groups (Quechua, Aymara, Creole, etc.), geographically-located identities (camba (one from the lowlands) v. kolla (one from the highlands)) and socio-economic classes (rural peasant groups, participants in the “informal” urban economy, the wealthy urban and rural upper classes and the growing urban middle class). In fact, nearly every term used to designate a particular identity in Bolivia (campesino, cholo, indio, camba, kolla, etc.) has been appropriated and re-appropriated by both those who denounce that identity and those who claim it as their own. This startling multiplicity of identity has complicated political and social interventions, though generally (and especially recently, since 2003) government programs of social inclusion and “capacity building” among various identity groups have prevailed. This “re-figuring” of the political landscape away from a hegemonic, solidarity-inspiring conception of the “national”, the “Bolivian” or the “society” (“as a whole”) mirrors quite closely Rose’s (1996a: 333) conceptualization of the formation of the neoliberal project around “communities”. These “communities”, however defined, have become the privileged site of government intervention, going so far as creating territorial-based organizations (organizaciones territorales de base, OTBs) under Law of Popular Participation of 1994, tightly defining rights and privileges of rural indigenous communities (especially around the Quechua ayllus of highland Potosí department) and giving them a measure of autonomy in their own territory. As they were enacted under a government which later went on to brutally suppress indigenous uprisings in February and October 2003, these reforms can be seen in hindsight as a cynical tactic to exclude through co-optation the political power of the majority of Bolivians (over 60% are identified as “indigenous[2]”), though it must be said that the reform was promulgated in response to growing calls for inclusion of indigenous, especially Aymara and Quechua, political systems. Interestingly, until the current presidency of Evo Morales, reforms of this nature were generally demanded first by the explicitly ethnic or geographical groups and were strongly resisted by the central government, which preferred to preserve the “single matrix of solidarity” (Rose 1996a: 333) of a more socially-based territory. It seems that the Bolivian population has generally led the state in the move towards ideological (though certainly not economic) neoliberalism, creating an intricate and often paradoxical theoretical landscape.

Naming names and making space; or: Is it better to give than to receive?

Rural highland Bolivia is by and large only accessible with difficulty, over poorly-maintained dirt roads and with a 4-wheel-drive vehicle. The roads between the small communities are poorly marked. Outside of every community, however, there are cement-block signs, whitewashed and painted with the name of the community, the names of the organizations supporting projects there and the projects themselves, as seen in Figure 2. The sign shown is found in the community of Antigal, about an hour and a half by jeep from the city of Tarija, in the Municipality of Uriondo. Similar signs dot the roads branching out in all directions from Tarija, usually the only markers for the turnoff onto the dirt tracks snaking up the walls of the valley into the communities themselves. The two most common types are from CARE’s SEAS program and from Plan International. Though CARE is a traditional development NGO and Plan International is ostensibly a child sponsorship organization, their projects in the region are essentially the same: basic infrastructural improvements (drinking water, irrigation and road improvements) and public health interventions dominate. With few road signs marking routes and even fewer announcing the presence of a rural community, NGO signs are the landmarks around Tarija.

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 Bolivia and abroad. The full exhibition consists of more than thirty black-and-white images, though in this analysis I will concentrate on the eight photographs (Figures 3-10) available freely on the website of MSF’s Spanish branch (Médicos sin fronteras: “Visita virtual”) because of the difficulty and time involved in gaining access to the remaining photographs. It must be mentioned that the two formats have distinctly different intended audiences. The free exhibition which I viewed in La Paz in 2006 was mainly attended by the middle classes of La Paz, who are understood to have a certain knowledge of the regional context of the images, viewing the people portrayed as more mundane than exotic, a byproduct of the inequality which has produced the viewers as comfortably wealthy while producing the objects of the photos as miserably poor. Viewers abroad, however, are not expected to feel the same affinity or even to recognize any connection as part of the same political economy. Outside of the Bolivian context (which is not itself entirely homogeneous), these images portray the exotic, impoverished Other towards whom the viewer is expected to feel pity. For example, in the eight photographs presented there are six women shown. Of the six women, the only ones to appear in “Western” dress are the ones clearly identified as employees of MSF, while the other three all appear in dress which is typically characterized as “traditional” to southern Bolivia. In that women are often portrayed as the guardians of “traditional values”, here they can be seen as serving as symbols of the adherence to “tradition” in Bolivia. The images imply the distinction between “tradition”, disease, and underdevelopment in rural communities on the one hand and “modernity”, health and development as brought by MSF on the other[3]. Beyond merely implying a division between active subject and passive object in the existence of the advocacy program in itself, MSF underlines and reinforces this distinction through its portrayal of rural Bolivians in the eight photos selected for electronic distribution. In none of the photos is someone readily identified as a member of the community (i.e. not wearing clothing marking the person as a worker for MSF) portrayed as an active participant in the fight to rid the area of Chagas, and every time an MSF worker appears, she or he is portrayed as actively teaching about, diagnosing or treating Chagas disease. Though MSF makes a case for the active participation of the target population in its interventions, its discourse of advocacy systematically denies and excludes any agency except that exhibited by those working explicitly through its own organization.

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 USA, describes its mission as

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 United States) to “save” the country is made abundantly clear.

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 Bolivia actually serve to reproduce the unequal power relations which they purport to address. I fully recognize that I haven’t done a full analysis of the effects these programs have had on the target populations and the societies as a whole as they exist in the area. Nor have I properly researched the dynamics of the production of these projects, leaving the projects to “speak for themselves”. I have attempted to place the projects themselves in the regional context, with a distinct look towards the identities assumed and the identities created by the discourse used.

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 Bolivia. I find that their discourse consistently constructs those of their target population as lacking the necessary agency to improve their conditions, incorporating them as junior partners, if at all, in their own lives. This discourse has its uses, raising funds and in many ways bolstering the position of the NGOs and facilitating their interventions which often bring concrete benefits to many “underserved” populations, but it also reproduces the power structures responsible for the conditions in the first place. In order to (more) fully break free of this cycle, knowledge stemming from aid organizations must be fully situated, removing the NGOs as the privileged, unmarked and hence unscrutinized, fountain of knowledge. In this way, by marking both (or all) parties as knowable objects (in addition to subjects of knowledge production), power structures can more easily be analyzed and accounted for (rather than completely dismantled). Truly, the problem of “development” in the Third World (as framed by the developer/developee binary) can only be overcome by removing “development” and its discursive baggage from the equation.

[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, Municipality of Uriondo, Tarija, Bolivia
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 USA's "I am powerful" campaign (CARE

USA

)

Figure 12. Interior improvement of housing

Figure 13. Exterior improvement of housing

Bibliography

Armstrong, David (1995). “The rise of surveillance medicine”. Sociology of Health & Illness. 17:3: 393-404.

Brigg, Morgan (2002). “Post-development, Foucault and the colonisation metaphor”. Third World Quarterly. 23:3. 421-36.

CARE International. “Our Approach”. http://www.care-international.org/index.php?option=com_content&task=view&id=32&Itemid=36.

CARE USA(a). “I am powerful”. http://www.care.org/getinvolved/iampowerful/intro.asp.

CARE USA(b). “About CARE USA”. http://www.care.org/about/index.asp.

CARE USA(c). “health”. http://www.care.org/careswork/whatwedo/health/index.asp.

CARE USA(d). “health: children’s health”. http://www.care.org/careswork/whatwedo/health/children.asp.

Columba, Claudia. “Chagas: when children are the heroes”. http://www.planusa.org/contentmgr/showdetails.php/id/58499. Plan USA.

Crisp, Brian and Michael Kelly (1999). “The Socioeconomic Impacts of Structural Adjustment”. International Studies Quarterly 43(3): 533-52.

Donley, Kelli (2006). “Kelli’s Corner: Access to the sea would make a world of change”. Esperança, Inc. Newsletter. November. 2. http://www.esperanca.org/pdf/November06.pdf.

Escobar, Arturo (1995). The Making and Unmaking of the Third World. Princeton: Princeton University Press.

Ferguson, James (1994). The Anti-Politics Machine: “Development”, Depoliticization and Bureaucratic Power in Lesotho. Minneapolis: University of Minnesota Press.

Foucault, Michel (2003). The Birth of the Clinic: An archaeology of medical perception. Oxon: Routledge Classics.

Haraway, Donna J (1991). Simians, Cyborgs and Women: The Reinvention of Nature. London: Free Association Books.

Hirschman, A.O. (1967). Development Projects Observed. Washington D.C.: The Brookings Institution

Jones, Peris S (2004). “When ‘development’ devastates: donor discourses, access to HIV/AIDS treatment in Africa and rethinking the landscape of development.” Third World Quarterly. 25:2. 385-404.

Kapoor, Ilan (2004). “Hyper-self-reflexive development? Spivak on representing the Third World ‘Other’”. Third World Quarterly. 25:4. 627-47.

Médicos sin fronteras. “Visita Virtual”. http://www.msf.es/noticias/especiales/especialchagassilenciosoysilenciado.asp

Plan International. “Plan Bolivia”. http://www.plan-international.org/wherewework/americas/bolivia/.

Plan USA(a). “Our Story”. http://www.planusa.org/who/ourstory.php.

Plan USA(b). “Bolivia”. http://www.planusa.org/contentmgr/showdetails.php/id/88297.

Robertson, A. F. (1984). People and the State: An Anthropology of Planned Development. New York: Cambridge University Press.

Rose, Nikolas (1996a). “The death of the social? Refiguring the territory of government”. Economy and Society, 25:3. 327-56.

Rose, Nikolas (1996b). “Governing 'advanced' liberal democracies”, in A. Barry, T. Osborne and N. Rose, eds., Foucault and Political Reason, 37-64. London: UCL Press.

Sachs, Jeffrey (2005). The End of Poverty. London: Penguin.

Sachs, Jeffrey, Jeremy Bulow and Kenneth Rogoff (1988). “Comprehensive Debt Retirement: the Bolivian example”. Brookings Papers on Economic Activity, 1988(2): 705-715.

Sachs, Wolfgang, ed. (1992). The Development Dictionary. London: Zed Books.

Schroeder, Kathleen (2000). “Spatial Constraints on Women’s Work in Tarija, Bolivia”. Geographical Review, 90(2): 191-205.

Spivak, Gayatri Chakravorty (1988). “Can the Subaltern Speak?” in Marxism and Interpretation of Culture, C. Nelson and L. Grossberg, eds. Chicago: University of Illinois Press. 271-313.

Spivak, Gayatri Chakravorty (1999). A critique of postcolonial reason: toward a history of the vanishing present. Cambridge: Harvard University Press.

what i'm on about

2007-04-29T11:53:00.000-07:00

so this blog is ostensibly about post-development, critical development theory, or what i would prefer to call critical theory as applied to this thing we call "development". i guess now is as good a time as any to explain what the hell that is (because i've been struggling with a literature review on critical development theory). i guess that's two things to talk about--critical theory and "development"--but they slot together nicely.

critical theory first: it all started (as things often do) with foucault. the historian/philosopher, not the professional dominatrix, not that he would have been bothered by BDSM. anyways, the point is, that between his 1961 publication of Madness and Civilization and his death from AIDS in 1984 he basically turned the philosophical world upside-down. his basic insights were on the productive (and re-productive) capacities of power, not the sovereign "i'll kill you if you don't do as i say power", but the subtler power of knowledge and discourse. he saw in the increasingly complex "panopticism" (see: Jeremy Bentham, but really its just a metaphor) of society a form of social control in which the subject is interpellated (here he's/i'm drawing heavily on his mentor, Louis Althusser) to understand him/herself as an active subject in her/his own life, and society is increasingly structured to produce such subjects. in Discipline and Punish, he goes on for quite a while detailing how the modern punitive system, the most obvious form of societal control, has evolved, from a reliance upon punishment and spectacle to a use of "discipline" and surveillance to keep us in line. the thing is, society is structured to produce us not as objects of power to afraid to step out of line, but as subjects of power who understand our need to stay in line, constantly monitoring, evaluating, ranking and re-ordering subjects as a mechanism of social engineering (though i don't think he would have expressed it as such). this runs from prisons (obviously) through social institutions such as education, welfare, social services, etc. the knowledge generated by constant surveillance (and evaluation--tests) fixes us in the gaze, creating us as useful subjects for this new disciplinary power. The Birth of the Clinic, an earlier book, writes on this knowledge-power production in the terms of medical perception, and later works go on to explain governmentality (literally, government and mentality--we are mentally prepared to govern ourselves and are thus governed), the creation of sexuality, etc.

ok, so this is where it gets interesting. i know not all "critical theory", an ambiguous and nebulous term if ever there was one, is based on the work of foucault, but i know him best and its a convenient starting point. critical theory later was taken up by people in diverse fields: Nikolas Rose (governmentality and neo-liberalism or "advanced liberalism"), Judith Butler (often credited with starting gender theory), AIDS activists (see How to Have Theory in an Epidemic by Paula Treichler) and basically anyone else in anything related to a social science or a humanity. what i'm specifically interested in, i suppose, is how this plays out related to "development".

so, development is: a transition from one (lower) state to another (higher) state; its a state of being developed; its a uniquely apolitical political project of "helping"/"modernizing"/"civilizing" the third world/the poor countries/the south/the not-western europe and north america. but i'm getting ahead of myself. the term development's been around for quite a while, being used synonymously with "evolution" basically since the term "evolution" was coined, but after world war II, when everyone in the world except the US was in a shambles, it took on its modern form. people will refer to Truman's inauguration speech (and the famous Point 4) for first using the term "underdevelopment", but it was around for a while before, being bandied about in various early UN documents etc. but basically, the important thing was, "underdevelopment", suddenly, when it was "up to" the US to put the world back together, became a measure of what you were not: the underdeveloped are not developed; they are not modern, they are backwards; they are not healthy, they are sick; they are not rich, they are poor; they are not powerful (even enough to assert their own agency effectively), they are weak; they are not educated, they are illiterated and mired in "tradition" and superstition. Esteva does a great job of saying all of this and more in his chapter in The Development Dictionary (ed. Wolfgang Sachs). The point is that now the norm that foucault talked about in education, in mental illness, in medicine, was now being applied to entire countries and populations, erasing heterogeneity, disavowing agency (in some cases), ascribing agency (in others), basically making a mess of things. not that development is all bad, but i'll get to that later.

so there are all these theorists and academics (who aren't necessarily so interested in the theory) that have taken what foucault have said and run with it. Arturo Escobar (best resource: Encountering Development: the making and unmaking of the Third World) sees the knowledge production of and around development as fundamentally subjugating (ironic how i say this and actually mean "objectifying", but still) the third world, and, what's worse, the development project as only being a tool for further increasing northern capitalist access to southern markets. James Ferguson makes a better foucauldian critique of development (power, bureaucratization, depoliticization, etc.) in Lesotho in The Anti-Politics Machine (1994). others have criticized development as a whole (most notably for the blatant parallels between development discourse and the justification of the "civilizing mission" of colonialism, but i don't have good citations for this because i haven't kept up well enough with stuff i did in past classes) and generally (though this is coming from a lot of people (Gayatri Chakravorty Spivak and Edward Said, notably) who wouldn't call themselves foucauldians i would imagine) for being too wrapped up in problematizing (and even perpetuating) Otherness or (sub)alterity.

so yeah, "development" is this loaded word that it's probably just best to avoid, or at least to put inside as many "scare quotes" as possible (i found that funny). it implies all sorts of dichotomies/binaries between the high/low, good/bad, light/dark, knowable/unknowable, rational/irrational, modern/backwards, educated/simple, powerful/powerless, etc, that basically serves to construct poor (dark) people in poor (non-western) people as objects of knowledge (to white "experts" from europe and north america), all the while protecting the Norm of the rich west, leaving its hegemony uncriticized and unscrutinized. so in fact, while telling us that africa, asia and latin america are "opaque" and "unknown" (and thus something that we must study), it really is protecting the opacity of the west and masking the systems of power and the "representational economies" that have produced such inequality and power relations. i know thats not very clear and actually fairly recursive and self-referential, but the fact is that that's what i'm getting at: things are produced by power and thus produce power (or perpetuate this productive power) which then re-produces them as objects of power, etc. and so forth and so on. Haraway calls this the "God-trick", purporting to see everything from nowhere, denying the subjectivity of perception by "experts" (in biomedicine, development, economics, whatever) while emphasizing the partiality of the knowledge the objects of knowledge: in calling for "indigenous knowledges", "empowerment", "community participation", really what people are doing is acknowledging that these situated knowledges (ie, stemming from a particular source and thus subjective, not whole, not omniscient) exist and are valuable, but it ignores the fact that all knowledge is situated--historically, racially, geographically--letting us let ourselves believe that we really can know everything. this privileging of western knowledges is what at the root is producing the unequal power relationships, is what makes us think that "Western" is synonymous with "developed" and what allows us to problematize and even pathologize conditions of life in other parts of the world.

but, i don't agree with all of this, most notably what escobar has to say about the integration of the third world into international capital markets. this isn't some giant conspiracy to just fuck people over for the sake of it, its more about power relations being created to structure our world as we perceive it which necessarily subjugate, objectify and degrade some people to further exalt the position of others. and then our attempts to help further legitimate and harden these power relations, whenever we assume the agency "on the behalf of" others. i once asked a teacher "so what's all this development activity do, if its not eventually working to eliminate inequality?" and he said "to perpetuate itself, to create more developers". which is probably true.

anyways, that was a hasty conclusion to all that writing, and anyway the paper is over and done with, and i'm in madrid, so i'm not gonna worry about it much anymore. hopefully a post will come soon that explains a little better what i was talking about in the last paragraph. hasta luego.

it lives!

2007-03-07T15:05:00.000-08:00

nik, matt, i'm sorry, i've gone home and thought about it, i've slept on it, but i refuse to believe in the "death of the social" (from: Economy and Society. August 1996 (25:3). pp. 327-356). your assertion that, under a pervasive system of neo-liberalism, the social has ceased to be a functional object (and thus subject), i feel is, if not completely false, let's say, to be kind, a gross exaggeration. nay, perhaps even an over-exaggeration. allow me to explain:

lets start with what i understand from you/agree with:

i accept that neo-liberalism, far beyond being a mere organization of the "economy" (in the narrow sense of the word), is an ideology and a structure of (can't avoid it) society as a whole. it pervades every aspect of our lives, creating us as subjects, as individuals, and most importantly, as citizens, which of course entails rights and responsibilities, in the proper old liberal sense. i understand that this "command to make live" implies that we must make ourselves live, that we understand that it is our responsibility to stay healthy, to manage our own finances, to raise our own children, to govern our own behavior. i completely agree that this then creates us as individuals, and thus makes the individual the privileged subject/object of power, in the sense that we know and accept that we must govern ourselves and that if we get poor and fat and our kids hate us and we end up in jail, its our own damn fault. yes, of course, "government" these days is more about how we can get ourselves to govern ourselves as individuals better. no, government doesn't force us to. yes, government does construct us so that we want to. and blablabla knowledge is power etc. yes, i get it.

ok, now that we've gotten that straight. besides not believing that any of that can't be found in Discipline and punish if you look hard enough, i don't believe that any of that implies the destruction of the social as a grand idea that we actively and occasionally (or constantly) inadvertently create and even act upon. the object of the state in its most raw form is to organize and manipulate (and yes, i know that this can be a positive thing, stop reminding me) society. it doesn't give a shit about what you or i do, we're simply numbers, blips on the radar, ripples in the pond, drops in the bucket, literally one of millions. see, just as statistics and the social sciences bring us to the forefront, it does the same for everyone else. they exalt us as the "one indivisible", and they debase us as "just another". we're constantly studied, analyzed, observed, and put back on the shelf, classified and put in our place. in both the taxonomic and the bitch-slap sense.

the point is, i guess, that power paradoxically is constantly creating what it destroys. or that these powers are constantly creating what they destroy. an example that you brought up, matt, was about how social (social! you said social! ha i win!) change actually comes about: by destroying, othering, excluding, rendering voiceless and unimportant, it creates communities of those to whom it has applied the labels, it energizes, it very, very literally tells people what they are and points them in the direction of other people that they should identify with and tells them to all sit together at lunch, and eventually the table's gonna fill up and they're gonna start taking spots at other peoples' tables, and eventually they're gonna catch on that there's no special reason that they have to all sit together, especially now that they're all sitting at a bunch of tables, and they're gonna start demanding to sit with everyone else just like everyone else. or something like that, that was a very long metaphor. so, where i was going...was that in creating these groups, these labels, this power actively creates the groups that will challenge its hegemony. it creates by destroying and is thus destroyed by creating. brilliant.

it acts slightly differently in creating/destroying community. neo-liberal power, and generally any power that could possibly fall under the rubric of "governmentality", is completely dependent on the existence of society for its own perpetuation. we've been going on in class for a couple of weeks now how suddenly there's this "innovation" that, instead of seeking to promote its own power, power justifies itself as being "for the good of everyone". which is measured precisely through reference to a "whole" (society) constituted by the "parts" (individuals). yes, the social is destroyed as the object upon which power acts so that it may be reconstituted as the sum and goal of the new objects of power.

moreover (and now i remember why i made that argument a paragraph ago), those who dream of a coherent society, who see individuals as being created by a society and not creating it (among whom i would assume foucault to be, of all people), by being excluded by the neo-liberal workings of governmentality, are not destroyed, are not made to disappear, they are forced together, energized, organized, motivated, inspired. anyone yelling about structural violence, the poverty trap, fuck, those applying critical theory in developmentalism, they call themselves postdevelopmentalists (sometimes), they're yelling exactly about this, that neo-liberalism's got the focus wrong, its working on the wrong level (or at least not working on all the right levels). there's a very strong push in postdevelopmentalism to "encourage" (and the terminology is already in a minefield) government involvement, promote government initiatives that, instead of "empowering" the individual to suffer the consequences of the global economy, seek to rectify the negative effects power on the individual through society-wide initiatives.

dude, like, wouldn't it be cool if we could all be nicer to each other?

2007-03-07T14:54:00.000-08:00

so this is an email i wrote today to a friend who challenged me to come up with a way that i might apply what i've "learned" in critical theory (especially gender theory) to real life (other than the ability to use "scare quotes" all over the place--look, i did it again!). unfortunately, it is long and ultimately i came up with nothing at all concrete above and beyond "i guess i can try to be nicer to other people". so much for my first foray out of academia and into the real world. nevertheless, i really enjoyed writing it and wanted to share it with my imaginary audience. enjoy, my imaginary electronic friends!

[my friend], i've been thinking about what you were saying. i understand your frustration with so much of the talk about feminist/gender/critical theory. i know it gets tedious, depressing and a lot of time seems ultimately futile. but i've thought of a few things that i can and will endeavor to do that spring from my ideas on gender: (i don't mean to make this super-personal by always referring to i/you, but it seems easiest to take our relationship as an example)

i can see you as an individual first, someone who is religious, thoughtful, caring, compassionate, passionate and eager to learn and understand. i don't know where seeing you as a woman or (doing my best at) understanding you through your experiences as such comes in, but i know that it will not be first, and possibly might not even be in the top five.
as such, i will not make facile assumptions about your sexual preferences based upon your gender as you present it. i know that whether you wear a skirt or pants has nothing to do with whether you like to have sex with men, women, both, neither or another category altogether (that i must admit i have difficulty in imagining--but hey, i know that i'm a product of my (necessarily) limited cultural formation).
because i refuse to accept the validity of any link between your (or anyone else's) anatomy and your sexual behavior, i will not recognize any combination of the two as "natural" or "normal", and thus will not judge. the creation of "sexual minorities" necessarily implies a cultural preference for those in the majority.
moreover, i know that your sexual behavior is only one set of behaviors out of literally thousands that you go through everyday. there is nothing necessarily more telling about what gender you prefer for sex than, say, whether or not you floss, or if you prefer tea over coffee.
if you choose to base your identity around your sexual preferences, your anatomy, your gender, etc., i will of course accept that as a valid form of self-expression and self-identification, and do my best to see you as you see yourself (though of course i will still see you as i see you, as a product of my own life experiences and understanding of the workings of the world--we are all products of our environments, and we perceive as such). i will not, however, accept it as necessarily any more or less valid than if you instead chose to base your self-expression and self-identification around your skin color, your language, where you were born/grew up, where your ancestors were born/grew up, your religion or your socioeconomic place in society (and anything else that i couldn't think of). i understand that throughout your life, hell, throughout your daily activities, you will express different identities with differing strengths based on different circumstances and situations. your identity is your own, and it is certainly a lot to ask that it remain static.

so, based on those five points (and probably others that i can't think of off the cuff), i hope to see you as an individual with varied, overlapping identities, among which are your sexual and gender identities. of course i will see you as a gendered and sexed individual, but i will do my best to keep those identities in context, and without making value judgments. i know that i can't ever see you exactly as you are, because through my upbringing i was taught to always associate certain signs with certain characteristics, but hopefully i will be able to recognize those instances and do my best to overcome them.

hopefully i can bring those ideas into my interactions with everyone, and, i hope, they will do the same for me. i know im reaching for the metaphor (and there are all sorts of problems with me evoking it now, from my specific place in history/society), but: i know the civil rights movement wasn't perfect, wasn't complete by any means, and it's certainly not over. but it was a start. it told us that hey, it's not ok to assume anything about a person based on the color of their skin. and even though we all still do it, it's a start, because hopefully now we can recognize that we do it. and slowly learn to stop doing it, over the course of generations. there are going to be setbacks and problems, this is by no means a linear progression from racist to race-less, and it will probably never get all the way there, but at least it's a goal to work towards. the same with gender.

the civil rights movement (and the preceding experience, especially in the south) also was a vivid example of the inherent inequality of separation. separate implies inequality. the same goes with gender.

gender studies (and critical theory, more broadly) seeks to understand how we very literally construct our reality. we assign names, values, normalcy, pathology and deviance to all sorts of behaviors, attributes and random little traits without even thinking it. you can't really be "ok" with homosexuality unless you think of it as completely "normal", and in order to do that you have to expand your definition of normal (and then on infinitely for every minor variation in the theme of human sexuality), or better yet, do away with your understanding of normal altogether. by defining, listing, ranking and grouping, we simplify the world so it is possible for us to understand it (which is probably completely necessary--i doubt that the human mind could make sense of anything without placing it into some sort of pattern). but in so doing, we also lose detail, and, more importantly (i think), we create hierarchies and power dynamics.

which of course is inevitable. the best we can do is seek to work within the system (which of course is a strange thing to say, since it's impossible to imagine anything that's truly outside of the system), putting our best understandings into practice, using our knowledge of power to get it closer to equal. i'm not an activist, i don't know how to get this message out to "the people". i'm not a politician, i don't know how to legislate this and thus give it the authority of law. i'm a student, the best i can do is understand, acquire knowledge and build upon it in new and creative ways. but i'm also an individual, and society is made up of millions of individuals like me: if individuals take these ideas up, so does society.

so that's about all i can tell you right now. i can take these ideas, apply them to my life and my interactions with others, and hope that in the future perhaps other people might as well. i know that that doesn't go much beyond some naive hope that "maybe we can all just get along?", but to be completely honest, that's the best i can come up with right now. we can also share our knowledge, our understandings and our experiences, and hopefully combine them in new ways to come up with the "next big thing" and put this stuff into practice in the larger society.

an explanation is in order

2007-02-22T16:11:00.000-08:00

right, so i'm gonna go ahead and blame my lack of writing (as if anyone cares) on having to read and write a good bit for a couple of my classes. basically these two classes boil down to a critical (read: foucauldian) look at hiv/aids and healthcare discourses, respectively. anyways, to rectify this disappointing dearth of reading material (i'm just being an ass: ignore me), i've posted those two research proposals i've been working on the last week or so. i think they're good enough to stand on their own, at least as presenting an argument and working as an introduction to something that will (hopefully) include some actual evidence rather than relying simply on my poorly-documented claims. ah, the demands of the academic discourse. right, so, please read, and let me know of any insights/criticisms you (all two of you reading this) might have.

The representation of women and the spread of HIV

2007-02-22T16:00:00.000-08:00

The spread of HIV throughout the world has certainly served as a screen against which preexisting power modes of power been projected, power which has defined and controlled the production of identity of a myriad of “risk groups”, presenting us with the “homosexual”, the “IV drug user”, the “prostitute” and the “long-distance truck driver”, to name but a few. By creating these discrete groups (which are generally understood to be mutually exclusive, not only to each other, but also with the “norm”), subjects have been created, subjects whose possible trajectories have been pre-determined, whose “otherness” as been taken for granted and whose voices have all but been lost in the crowd of the researchers and academics who have written the definitive accounts of “the AIDS epidemic”. While this paper will certainly only be adding to that crowd of academics (though nearly imperceptibly), I hope to elucidate some of those modes of power which have created distinct groups by simply the application of a name, thus cordoning off certain behaviors, nationalities and even genders from the “general population”.

This paper will seek to understand the contradictory representations of “women” in HIV/AIDS discourse. While Treicher notes the lack of research interest in, if not the outright denial of, women’s involvement (or at least the involvement of “normal women”) with HIV in the 1980’s, attitudes have shifted significantly in the 1990’s and the 21^st century, where women have frequently been portrayed as “vectors of disease”—prostitutes transmitting HIV to their clients, mothers transmitting HIV to their children, and, more generally, women holding “the key” to preventing the spread of HIV to the “general population”. Beyond merely placing blame or responsibility for the transmission of the virus, women have also been denied a place among the ranks of “victims”, appearing as carriers or not at all it would seem.

Moreover, HIV is a very strongly sexed pathogen. Due to its beginnings (in the North) as a disease of the gay man, it became and has remained a male disease. Women were reassured that this STI would not be transmissible to them, that this was simply the “fatal price of anal intercourse” (interestingly, also defining heterosexual sex as purely vaginal). Through this characterization of HIV, men were defined from the outset as the primary concerned population.

This “male disease”, it will be shown, is a product of a consistently patriarchal system of symbolic representation, as described by theorist such as Irigaray, Beauvoir and Butler. In the theory of Beauvoir, women are linguistically defined as the sex which is not male (which is defined as the “universal”), they exist as the only marked sex, indeed, they exist as the classic “other” which the “normal” uses to both construct its own identity and obscure its very construction. Irigaray takes a seemingly oppositional approach, seeing women being left as the undefined and undefinable completely outside of an uncompromisingly patriarchal linguistic system; indeed, women are everything that fails to be male, thus defining women as a multiple gender (or the “sex that is not one”). These two theories, however, seem to converge in agreement that the male is the “norm”, the “default”, leaving “female” to constitute something “abnormal” and certainly, leaving it simply as “not-male”.

Under the lens of these theories, it will become clear how this disease, first described in the “all-male” world of the homosexual community in the United States, consistently failed to be given a designation of anything other than this false universality of masculinity. Though very little has actually changed in the representation of HIV infection (as a “gay”, or “male”, disease) in the North, the representation of HIV as a male disease has had to undergo significant modification to “fit” the pattern of transmission in the South, especially in Africa. In Africa, HIV infection, most often transmitted through heterosexual exchange of fluids, has been characterized as a disease of displacement (echoing, perhaps, the 19^th- and 20^th century discourses on tuberculosis as a “disease of civilization”?), affecting primarily those displaced and living along the paths of major population shifts. Here, there is much talk about long-distance truckers and migratory labor (including mining and agriculture), where prostitutes, beyond receiving blame for their infection and transmitting it to others, are consistently relegated to the position of the passive “pool” of infection which spreads then to the more “active” individuals, ie, the mobile males. Further along the represented chain of infection (which is in no way merely linear), women are again left out, receiving no mention as receiving HIV from an infected partner, but again garnering blame in passing HIV on to her innocent unborn offspring.

Throughout this paper I will also refer to the contradictory roles defined for women, both as the dangerously sexual deviant (or temptress) and as the impossibly passive maternal caregiver, and how these defined roles are both a product of and productive of the discourse obscuring the role of women in the global epidemic of HIV infection (whether or not one chooses to “believe” in AIDS as such). Overall, I hope to show that the rigidly binary production of identity (male/female, gay/straight, the norm/the other) seriously obscures both the mechanisms by which these designations are produced and the effects of these designations, especially in the transmission of such a “political” disease.

[check out:

Butler, Judith (1990) Gender trouble: Feminism and the subversion of identity. (New York: Routledge).

Foucault, Michel (1973) Discipline and punish: The birth of the prison. (New York: Penguin).

Treicher, P. A. (1999) How to have theory in an epidemic: cultural chronicles of AIDS. (Durham: Duke University Press).

that should get you started, but if you're still needing more, check out books by Simone de Beauvoir and Luce Irigaray or "Bodies that matter" (so i'm told, i haven't actually read this myself) by Butler (above)]

The Gaze, Advocacy and the God-trick

2007-02-22T15:51:00.000-08:00

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).]

debt relief

2007-02-19T05:22:00.000-08:00

I've not written much lately (and i certainly won't until i can get some sleep later in the week), but here's an article i found on bbc that's just plain disgusting. honestly, who owes what to whom?

here's a longer piece from indymedia.co.uk on the same thing.

voyeurism

2007-02-06T11:10:00.000-08:00

watching a documentary today, even though it was quite well-made, relatively, made me think about how much we really do want to see others' pain. i've had very well-intentioned friends say they want to go to india (especially) with me because "it would be good for [them]". i can't even definitively say that that's not why i've studied, worked and traveled where i have. i would hope that it's been for more noble reasons than this, but who can really tell?

seeing the other in a state of misery always holds a sick fascination for us. car wrecks. natural disasters. grisly crimes. fat celebrities. look at the free papers littering the weekday cars of the london underground for proof if thats what you want. and documentaries, in their own highbrow, "concerned" way, perpetuate this. we watch documentaries to basically inform ourselves; not, mind you, so that it might inform our actions, improve the world, etc. (though many films have a definite political agenda, i would argue that this is secondary), but to inform ourselves of the other and thus derive entertainment from this. because basically, that's what it is. entertainment at the expense of others.

now i'm at least as guilty of this as most. during my "work" in bolivia (i'm also guilty of using too many air-quotes and parentheticals), i have to admit, i was basically useless. in fact, at my most helpful, i was actually there to document what was happening--the state of the garbage pits being done, the success of the campaign against chagas, etc. literally, my job was to listen and take pictures. to see how the other half live, and (at best) to witness it to the world. but during most of my time there, i would say roughly 5/6, i wasn't directly useful to my employers (and this i use in the loosest sense of the word), i was there as an outsider, gaining more personally (in the form of a boosted resume) than i could possibly give. and why did i go? what does it mean if i say "because i was curious"?

curiosity often drives us to the furthest reaches of the world. we go to see, to take pictures, to "get off the beaten path" (har har), and to "connect" with the "locals". but we certainly go for ourselves. i recently went to bosnia & hercegovina and croatia for a couple weeks' vacation. ostensibly, to get away from it all (sounds familiar? it should). find a few mountains or beaches where i could sit or walk undisturbed and be quiet for a while. which i did. i was very quiet. but i also went, and i knew/know this, because i was curious. i went, to put it most bluntly, to see what a country that was recently at war with itself looked like. i'm not proud of that. in many ways i feel that seeing something, experiencing something firsthand (and i know that's in many ways disingenuous, but let's at least say "as firsthand as reasonably possible") is important for personal growth and, at the very least, a context of what we see on the news. it challenges us and inspires us. but we're also growing personally because we're viewing the misery of others? sounds callous, because it really is.

and what of advocacy? msf is an organization that dedicates itself to "raising awareness of the plight of the people [they] help". of the two awareness campaigns that i've witnessed firsthand (chagas in la paz and cholera in oslo), that means they put on photographic exhibitions. which, in the case of both of these, brings the image to the forefront of the mind, but also in an "artistically brutal" manner. it's meant to evoke sympathy, support and eventually involvement, yes, but it also seeks to entertain the middle classes strolling past the exhibition centers on their sunday promenades. to give them a taste, in black and white (artistic photos are inevitably black and white at these events, while portraits of the children who drew the drawings are in color), of the "other", and let us visualize their suffering. at least 95% of those who pass through do nothing afterwards (and i'm one, i'm sorry to say), other than going out for an ice cream to cheer themselves up. sure, you can't expect everyone to be moved to their pocketbooks at every one of these events, but what does this predictable, apparently acceptable majority tell us? either that msf is doing a piss-poor job of advocacy (and i would not say that), or that the distance between the subject and the viewer is, and probably always has been too great.

we go to the slums, take pictures, keep the camera either always in front of us (like a plastic and glass shield, or better, a filter) or keep it always out of sight, embarrassed both to show our wealth, to display so openly our not-belonging, and to realize that we fear these people, as if their poverty is communicable (it is, but not in such casual circumstances: it effortlessly passes from mother to child), and, more precisely, we fear their jealousy, their wrath, their latent power. because in going to "bear witness" to misery, we always must assume ourselves separate and superior, assume that we must bring their experiences up to our level. in doing so, we also assume that that is their wish, to be like us, live like us, to be us. and that frightens us, because we're so devoted to our binary systems, our zero-sum games, that we fear their improvement. and we, in the development community, fear working ourselves out of a job.

[note: sorry, at the end, for just randomly throwing in thoughts. it's a lot less incoherent in my head. i think]

write what you know

2006-12-04T07:01:00.000-08:00

let's start out with an old essay/combination of emails that i wrote a few months back, at the end of my placement in tarija, bolivia with CARE and Esperanza/Bolivia.

This first excerpt is from an email to a friend who had lauded me for spending my summer doing what I’ve been doing. She herself is planning on a career in something that could be construed as service work, though she’s had very little direct experience in the field, especially outside of Atlanta.

your comment about living around/experiencing poverty (you were talking about me and your brother traveling to bolivia and south africa) sparked a line of thinking for me over the last week or so (since you emailed me, anyways). ive been trying to reconcile my gut reactions to poverty to the way i know i should act and the way i think i do act on the outside. when i see poverty (and here i mean poor people, but its quicker to write one word than two), my immediate reaction is to put away my camera, to be conscious not to stare, to try to act normal. but why should i have to act normal, why should it bother me? i thought about this and realized that for some reason i've internalized the notion, and i cant seem to dislodge it, that poverty is something that is shameful, and if they're not going to feel ashamed, then i'm going to feel ashamed for them. but still, thats not right, its not something shameful, its simply a result of a confluence of thousands of different factors, from global political economy to the distribution of certain disease vectors to racism and simply bad luck. so here i am stuck with all these preconceived notions about what it is im looking at and how i feel about it, and i dont want these notions, but i cant get rid of them, and then i realize i dont even know what im looking at. i mean, what is poverty here? right now i live in a house that i share with 6 other people, 7 cats and a very old dog. there's one bathroom, i have my own bedroom, and everyone else is two to a room. i can see significant patches of light through the door and walls of my room, and my only furniture is the bed and two shelves that i try to pile my clothes on. the bathroom is outside, there's no hot water to speak of, and i wash my clothes every week by hand in the sink and hang them out on the patio. in atlanta that housing situation would put me one step above homeless, but here, though im by no means in a wealthy neighborhood, im a long ways from indigent. so is something poverty in the us that isnt poverty in bolivia? not even talking about income, which depends a lot on exchange rates and purchasing power parity and all kinds of other economics-type stuff, but talking about actual housing situations, the way that i live, it seems poverty is relative. but how can it be relative when its based on such exact, non-relative material things? i know, i know, poverty many times is measured by the ability to access basic necessities, like nutrition especially, and in that case neither i nor anyone in the neighborhood around me is in danger of indigency. maybe the dogs, but certainly not the people. so then i start thinking about my specific situation, not that of the people in my neighborhood, but my state of wandering and doing volunteer work because i was rich enough and lucky enough to be smart enough to get rich people to give me even more money, money which would probably be better spent on bars of soap in rural areas than my actual labor for care. so i was born incredibly lucky, in probably the 99th percentile of luck in the entire world. what does that mean? does that mean that, since it was all dumb luck anyways, since its not my fault that im rich, that i am exonerated from any debt to society? or does it make my burden of debt even greater? thinking about it as dispassionately as possible, i cant really say that either one of those is the right answer. but i do feel a certain internal pull to simply leave the world a better place than when i found it, and the most direct way that i can think to do that (in a way thats pleasing to me, of course, which might not be fair to the people whose lives im trying to improve) is to work in public health in impoverished countries. so that brings me back to me in the act of seeing poverty. what are my responsibilities there, what is the right response? i know the wrong response is to look away, i do know that at least (i think). but is it my responsibility to bear witness, to spread awareness, or is that some sort of sick capitalization on their poverty, is that something like poverty tourism? i guess what im trying to say with all of this is that i have a hugely difficult time taking pictures of people, because i know that im taking the pictures because i find them different, i am in fact taking pictures of them because i conceive of them as the other, but i dont want to be seen as the other, and i wonder what people realize about my motivations (or people's motivations, in general) for taking pictures. while the camera allows me to bring a part of this world with me, to show it to other people and spread awareness, it also separates me, it gets in the way of interactions. so what it all comes down to is the fact that even though you talk about my experience abroad, my experience working with poverty, i worry about what kind of experience im getting. i mean, its so difficult to even define what im looking at, much less to define my relationship to it, and then im even ignoring (you will notice, in this entire email), the relationship in the other direction. there's just too much to think about already that i cant even begin to think about what other people think of me.

In this next one, I had actually forwarded the above to a different friend, to get a second opinion as they say. I got a response back, but I wanted to clarify a few things that I had said earlier, since it had been running around my head in the interim anyways.

anyways, it does seem like you understand what i was trying to say, and i appreciate very much your thoughts on the subject. the only part that i would want to add to what you've said is when you were talking about why we look away when we see someone who is less fortunate (and here im using the phrase to connote generality, not a euphemism) than ourselves. you end by noting that maybe its because we're taught to not stare, and i think that rings very true. but then that begs the question (in the common usage of the phrase, not the logical sense....just wanted to throw that in there for you) of why we're taught not to stare. we're taught not to stare because its rude, right? why is it rude? i'm thinking of this mostly in terms of the seeing-and-being-seen dynamic. if we stare, that is the most obvious (to the outside world) way to see. with it, it brings along a strong probability that the subject of that seeing is going to realize that they're being seen. this goes along with what i was saying about the camera, in a very literal sense. i think we are taught not to stare because we dont want that person, the subject, to know that they're being seen. why shouldn't we want that? quite honestly, im coming to a wall here. i dont know. but i think it has to do with the reaction that we expect our seeing, and thus their knowledge of being seen, to evoke. i think its like seeing someone naked. unless there's an obvious reaction, like a scream, or an erection, you dont know if that person is glad to be being watched, indifferent, or uneasy. however, we're taught that you shouldnt be naked, and thus that you shouldnt want to be naked, and above all that you shouldnt want to be seen naked, or better phrased, you should want to not-be-seen when circumstances dictate that you must be naked. why do teenagers and young adults, more than any other age group, get a rush out of skinny-dipping? clearly because of the mix of the erotic (which i would actually suggest is the less motivating factor) with the transgressive. we're not supposed to be naked, but lets fuck the man, we're going to be naked just to prove a point! ok, that metaphor's been extended enough. so we're looking at this poor or disabled person, and we've always been taught that you shouldnt be poor or disabled. not necessarily because there's a societal taboo like with nudity, but because we're taught that its intensely undesirable. and in that way it does go against all of our socialization. so because we realize this without thinking about it, without really even realizing that we realize it, we expect this to be a shared value with the person that we're seeing. we expect them to view their condition as intensely undesirable as well. and thus we expect them to realize that they are different, that they are lesser, because they are going against what society tells us is right, and therefore that they realize that the reason we're looking at them is because they are lesser. but then we've got this conflicting instinct, this thing we're taught about equality, and how better to pretend that we're all equals than by pretending that we're all the same. and thus to pretend we're all the same, we have to pretend that we don't see differences, and thus we have to not stare. i guess its not completely conflicting, because both of these instincts, the one about judging and the one about equality, have a strong underlying current of conformity. so you could probably look at it another way. if you've got two people, or better, a crowd, a group of people, and they're all looking at the same thing, they're all experiencing roughly the same external experience, and thus they feel strangely united. now im bordering on crowd psychology, which fergus tells me is actually a load of crap, but i dont know enough about anything to know why it would or wouldnt be crap, so ill continue. so there's this equality of looking at one thing, a speech or a performance or a fight or a plane crash or whatever. but then if you cause any two people to look at each other, they are forced to become separate entities, to understand that they are two people and that they have external differences as well as internal difference. they are forced to see different things, and this puts us in an uncomfortable position. we really just want to be connected with people, to share experiences, but not to impart different experiences. if two people are looking at people, they must come to terms with their nonconformity. thus begins the judging and the conflicting desire for equality and the uneasiness about the unknown factor of what the other person is experiencing, and what they're getting out of that experience.

This last one is certainly the angriest (again, sorry for the profanity). Beyond being frustrated with my placement (I was getting bored, and this is just before I made plans to start working with Esperanza/Bolivia), I was also frustrated about the situation in the Middle East (which directly affected someone very close to me) and a conversation I had had with a Peace Corps volunteer a day or two before. Basically, he seemed like a good guy (as I’m going to assume that most people who would donate two years of their life to service work in a developing country must be), but I was a little turned off by the inflexibility of his goals here. In addition to his normal project (beekeeping, basically), he wanted to teach rural adults (in a community that I’ve been to frequently) basic literacy in Spanish. Basically, as soon as he offered that, they told him no, they didn’t want to learn to read and write in Spanish (in my opinion, that community anyways is by far one of the more literate that I’ve seen), but they would like him to teach them English. Which I don’t think he took very well. Anyways, this little encounter really drove home the point that its not nearly enough to just have good intentions, you also have to somehow know what is best, and this idea of what is best must be agreeable to everyone involved. Or, to put it more simply, you can make some serious mistakes even with the best of intentions. So anyways, all of this, plus everything else I’ve seen and felt and done this summer made me seriously question (and I’m still questioning) what it is I really want to do with my life. For the past few years, I’ve been convinced it had to be something non-profit, for the common good and all that, that I couldn’t understand the people who just want to work to make money. Now, it’s not that I’m becoming more desirous of a comfortable life in the suburbs somewhere, but I’m certainly feeling a certain urge to run away from it all. OK, I think that went a little beyond context, since I explain most of that in this part, but here you go:

sorry for all the cynicism. i wrote jennie an email a week or so back, and she wrote back that she was really surprised by my writing style, because it didn't have a hint of any of the normal "patrick-cynicism". not a great way to be labeled, but i guess if the shoe fits. i think i'm more or less at the point where you were just after getting back. i'm so fucking angry and frustrated after seeing just a small, small view of how completely fucked up this world is, and my head hurts from banging it up against the wall and not getting anything changed for what i think is the better. it's too complex for me to totally understand, even after (what will still hopefully, i think, be) a lifetime of trying to figure it out, and as i start unwinding the threads, they just tangle themselves at the other end. i guess that's what "development" work is. the eternal firefighters, running from one blaze to the next, but always secretly fearing that the fires will finally go out, because then what will we have to worklivegetpaid for? a guy today was talking about something he saw on the internet, about how in 70 years there will literally be wars (as if there aren't already) over water. the destruction of the environment is progressing at a ridiculous rate, and what are we doing? my parent's generation is busy trying to get the last few drops of resources out before it's all run out. a few people just younger than them seem to be doing their best to help the people who have been ruined by the ruined environment, but knowinglyunknowingly placing greater burdens on them to preserve the few wild places left than were ever placed or are currently placed on the people bent on destroying those places (care, im looking at you), while the rest of the generation does their best to not see. and then there's us. it's our turn and i can't think of anything better to do, i'm ready to go back to atlanta and open a hookah bar with you and stick my head back in the sand where it belongs. my parents say often "we're so sorry for the world that we've left you and your children" and quite honestly, the best i can think of right now is to pass the buck. things aren't going to be better for my children, and certainly not for my grandchildren, in fact, they're almost guaranteed to be infinitely worse. i'm going to end up another old fart sitting around, dying of some sort of cancer (at least with smoking i can choose which type, with pesticides and petrochemicals i can't even hold on to that bit of agency), musing about how much better things were back in the good old 2020's and apologizing to my grandchildren about the shit that i've passed on to them. god, i hate it when people start things with "before, it was [like this, different somehow]". i've gotten into what i think is the good habit of always asking "before what?". here, the question is usually more pointed, being "before the arrival of the spanish? before the arrival of the incas? before independence? before the tin market crash?". still, even with such pointed questions, people can't usually answer. in fact, i don't ever remember getting some sort of satisfactory (for my curiosity) answer.

gargh, i don't know, everything is just too complex. life is really overwhelming, if you think about it. i mean, first you've got to eat, but make sure that everything that you're putting into your body is a) something it needs and b) something that's not carrying something that's going to hurt you. then you need to worry about expelling everything you take in, either as waste or energy or whatever. then you need to worry about keeping your outside, and limited parts of your inside, as close to sterile as possible, so as to make sure that what you don't choose to put in your body doesn't somehow get in anyways. then you need to find a place to sleep, and in more general terms just places to live, which aren't going to negatively affect the fine balance that you've constructed with all your selective intake/output. after all that is satisfied (or perhaps before), you're expected somehow "contribute to society" in a way which will merit society giving you these silly little slips of paper that tell the people in the grocery store and the pharmacy and the gas station and the apartment complex that you have been deemed fit to possess all these things that are necessary for your body. and simultaneously you're expected to actually be a part of the society that you're supposedly contributing to, but first you need to define what this "society" is that i'm talking about, it's limits and limitations, and then you need to go about locating yourself in this made up, bounded entity (or perhaps better: this entity with made-up boundaries). and then there are some of us that are stupid enough to think that we can somehow keep all these flaming, screeching llamas flying in the air above our heads while we reach for the flaming, screeching llamas of other people's necessities, trying to lighten their load because, for one reason or another, we have decided two very arbitrary things: first off, that these people are either incapable or unfit to juggle their own flaming, screeching llamas. and second, that for some reason we are. so then on top of all of that, first of all i've (now this is back to being a self-centered email) got to figure out why i've made these two arbitrary decisions, but i've also got to somehow decide for these people, whose flaming, screeching llamas are whirling over my head, the best way that these people's flaming, screeching llamas should be whirling. in this decision over the whirling, i'm supposed to balance something between what my desires and ideas are for the proper whirling of flaming, screeching llamas and whatever i can find out (and thus try to understand, but always wondering if it's really for my own purposes) about these other people's flaming, screeching llama whirling preferences. how do i weight whirling preferences? is one necessarily better, eclipsing the other, or do i need to find some middle ground, which would then be based on both my always faulty understanding and my equally (or perhaps more, but probably not less) faulty judgment of the merits of both sets of preferences? and then as if that weren't enough, i need to worry about the juggling of other people of other flaming, screeching llamas, because the way they make their llamas whirl might cause them to crash into mine, or vice versa, and if i really care about the flaming, screeching llamas of one set of people, shouldn't i care about the flaming, screeching llamas of all sets of people? or is ok to bound my concern for the juggling of flaming, screeching llamas? does the exclusion of one set of concerns based on supposedly pragmatic grounds call into question my concern for all others? does it even really matter, since these concerns have already been called into question in other steps in the process? all i can really say that is some days it seems like a really ridiculously huge burden to just have to wash my clothes, or brush my teeth, or eat or poop, knowing that i'm just going to have to do it all over again the day after that and the day after that and the day after that, and so on and so forth and forever and ever amen. why can't i just get all my sleep out of the way right now, sleep for 20 years straight, then get up and live last 40 or so years of my life without having to worry about it? it would thrill me just to eat one big meal that will keep me for the next few weeks, let alone the next few years or decades. it's enough to want to stick my head in the sand while i start up some useless cafe or company or whatever that serves clientele that could be just as well served at the cafe a few blocks down the street. but hey, at least i could sleep at night, rather than staying up all night writing stupid, desperate, crazy, barely intelligible emails to my best friend. and even now i know that i'm not being fair to people who are in no way hiding from the world by running a cafe, but really they're just following a dream, a calling, a lifegoal, however you want to define any of those things.

self-knowledge is a bitch, even severely limited self-knowledge like mine, if it even merits that label. so i guess the best thing i can do now is just to put my head down, not quite in the sand but certainly at least enough to keep the wind and burning sun out, and just head right on. yeah, i'm still planning on going to public health school, in fact, i've got something of a 5-year plan worked out. the problem is that i can't decide if i'm doing this because i really think it's the best thing for me to be doing (or for that matter, if i even care anymore) or if it's really just a lack of imagination on my part, an inability to imagine myself on a different track. yeah, i know stuff never goes as planned, and the some of the best trips i've taken have been approached with a complete lack of expectations, but i've got to have something to fix my sight on, mostly because i'm worried that without some sort of fixed point, i'll end up going knowinglyunknowinglyuncaringlyevenhappily in circles.