a Paul Farmer moment

Over coffee today, a friend asked me what I thought about the argument that welfare actually encourages, or 'rewards', single-motherhood, particularly among African-American women. I went into a long rant among structural racism in the United States. Earlier in the conversation, the friend and I had been talking about SDS and the student protests at Columbia University in 1968, which also had me ranting about structural racism in the United States.

Then, tonight, I read this.

I find two things objectionable in this. First, I find the recourse to genetics, and its reification of race as a measurable health indicator, objectionable. I don't find it surprising, though, given the current obsession with finding a genetic basis for every goddamn thing that could happen to a person.

The second thing I find objectionable is the article's concluding statement, wherein a researcher is quoted as saying, "Even though we don’t know how to prevent asthma, we really do know how to control the symptoms.” Excuse me? Haven't we just been presented with information suggesting that children who are darker and poorer and who have shitty access to both in-patient and out-patient health care are more at risk not just for asthma but for the complications of mismanaged asthma, including death? The 'socioeconomic' and 'environmental' factors contributing to asthma and to its poor management are mutually implicated here.

And may I also suggest that concentrating on the supposed genetic factors predisposing poorer, darker children to asthma contributes to the erasure of how structural violence, American style, plays itself out on their bodies?

What angers me is that the logical conclusion is that the way to prevent asthma is to not be poor. Duh. This reminds me of something I read when I worked at HSPH. A list had been formulated of the top ten steps one could take towards better health (or something like that). The first item on the list was "If you smoke, stop smoking." The first list was sent around with a second list critiquing first list's bias towards the presumed agency of individuals with poor health towards ameliorating their own conditions. The first item on the second list was, "If you're poor, stop being poor."

I wish I could find that list. I'd really like to hit the NYT over the head with it about now.

a smack in the jaw

Every Thursday, one of the clinics located on the campus of the local referral hospital holds a journal club. A doctor, resident, or medical student presents an article. The article is sent out by email earlier in the week. The person presenting gives an exegesis of the article, provides some contextual information, and discusses the article's strengths and weaknesses, and its applicability or relevance for clinical practice in Botswana.

My medical student friends joke with me now and again about how much medical knowledge I've picked up in the course of my research. I'm getting to the point of feeling that I 'speak doctor' well enough now, and that it's time to move on and find another perspective. (There are a couple of problems here: 1) 'med student' is the easiest role for me to slip into; 2) I have a good idea of what things look like from an American practitioner's perspective, but the non-American practitioner's perspective is not so easy to obtain, in part because of point #1.)

But no matter how well I blend in among the American doctor crowd, my little anthropological mouth fell open yesterday afternoon when the following article was referenced in a presentation on HIV and renal failure:

Cantor et al. 1991. Effect of race on expression of acquired immunodeficiency syndrome-associated nephropathy. Archives of Internal Medicine 151 (1)

All of a sudden, I was an anthropologist again.

Where do I begin? Is 'blackness' a risk factor for renal disease? Can data from 'black' Americans be extrapolated onto 'black' Africans? What proof is there that this has anything to do with 'blackness', or is 'blackness' here a gloss for the corporeal manifestations of structural racisms with their own particular histories? What to make of a medicine that refuses to relinquish or interrogate its categories and cartographies of difference?

There is so much -- about race, about the conditions of practicing American-trained biomedicine in 'Africa', about difference -- that is glossed over in these institutions. I keep my eye on it when I can, but so rarely does it jump out and hit me in the jaw like this.

I didn't design my research to be about race or racism, but there's absolutely no way I can talk about what's going on here without talking about it.