War & Bodies

Hello! It has been some time since my last post and that has been because I have been working on this post for literal months. This draft has been open on my computer and these words bouncing around my brain since the first day of our Medical Anthropology & Public Health module in February. In that time, I have been on three different continents and figured it was time to finally bite the bullet and try to put into words some of the thoughts that have been plaguing my mind.

Over the past few weeks, through lectures and seminars and readings and conversations with friends, the parallels between health and militarization have become more stark in my mind. There are a few ways, through language and action, that this relationship is hard to ignore. I am going to touch on three of them very briefly--

1. Our Bodies Are A Fortress

Think back to those high school biology days and learning about how our immune systems work. Textbooks were rife with military analogies, describing the different lines of defense and likening cells to soldiers. As a result, there is this very aggressive discourse around health and therefore illness. This aggression pins us and our bodies against anything that could be seen as "foreign" or an "invader." We donate money and run marathons and climb mountains to raise awareness and "fight" these different illnesses -- these inanimate states of being. Maybe this framing is used to remind us "who is in power" or to motivate those who are sick or to strengthen their courage. But is it always necessary or even beneficial to take such an aggressive stance? What do we say then in the case of autoimmune diseases or cancers where these "offenders" are not foreign but are apart of our own bodies? Is it always right to immediately "deploy the troops" or is there something to be learned from the old adage "you catch more flies with honey than with vinegar"? Could the way we respond to and deal with disease outbreaks or health challenges change if we re-frame our perspective of "fighting" them?

2. Procedural Medicine & Militia

Think about the ways medical professionals respond to or approach a health challenge. From my understanding, there is a relatively strict and defined procedure they follow. In addition to the procedural strictness, the power dynamic and structures of the medical profession can resemble a militaristic style. You do not question authority. You follow the procedures. You go by the book. There's a hierarchy, a chain of command, and your personal feelings on the matter cannot have any weight in the task that you set out to do.

Beyond the potentially visual resemblance between medicine and the military is the actual physical use of the military for medical purposes. This is becoming a more implemented practice and was seen with a new force in the responses to the Ebola outbreak between 2014 and 2016 - the US, the UK, and France all deployed various types and volumes of troops, in different capacities. Military involvement in health operations is not a new idea, but it is certainly growing - even China is preparing to offer their military personnel in international development or disaster response, which has brought up concerns in Southeast Asia for a number of reasons. The military can get involved for a number of reasons including -- sheer ability to take on the logistical challenge, reach, and strategy (recall a common US military mission to "win the hearts and minds"). There are, of course, both benefits and challenges to military involvement in health; as it becomes more common, more research is being conducted on how these benefits and challenges measure up and international guidelines are being formed.

3. Colonialism, Oppression, & Health As A Strategy

This last relationship has been the toughest for me to come to terms with. The idea that globalization may not be a good thing. That the field of "international development" in some ways perpetuates the same standards and roles of the dark period of colonialism and exploitation. In this field and in our global health interventions, we come into a community and in some ways completely uproot their practices in favor of what we have deemed is the "right way" to do things. We do this for the benefit of these people and therefore the world, we justify. But this is incredibly similar to common sentiments of the British or the French less than a century ago. In many instances, international health missions share similarities and reflect the legacies of colonialism and its dynamic of domination and dependence*. “Civilizing missions” of the colonial period were considered to be done for the benefit of the local population. For example, a thought process among French authorities after building a hospital in Algiers could be something along the lines of “This is what we have done for the people of this country; this country owes us everything; were it not for us, there would be no country”**. The benefits of providing health technologies or medicines was seen to justify their continued literal and metaphorical exploitation of the country.

Most of the world’s first experience with Western medicine was with colonial medicine*. This history impacts the perception of medicine and foreign intervention in a health crisis and could in part explain the community resistance and mistrust that was common throughout the Ebola epidemic, for example***. At the beginning of the year when I was searching for a research project, I found myself wondering why the London School of Hygiene and Tropical Medicine, as a leader in global health, had so few projects and connections in South America. Soon after, someone pointed out to me that the majority of the work carried out by LSHTM is in countries that were once under British colonial rule. These are the countries with which the UK has connections and "relationships" so it makes sense that an institution is able to set up and pursue research in these settings. It is also difficult to ignore that the international partnerships that were formed in the Ebola response echoed the period of colonization – the French aid to Guinea, the British aid to Sierra Leone, and the American aid to Liberia. Consequentially, the response in the three West African nations was slightly different and reflected the priorities and practices of each of their international counterparts.

In addition to responding to health crises in patterns that reflect colonialism, globalization in regards to health also looks like enforcing the "Western standard of medicine" (also termed "biomedicine") in communities that may not actually want it. The groups that come in to provide this aid invariably come from the same handful of nations that are in power and have been in power for the majority of the last few centuries. And while they often claim to work in the interest of the entire globe, this is not always applied in practice. Take the Indonesian influenza virus strain controversy of 2006. There is a mechanism in place that has nations from around the world, especially where influenza is quite rampant or virulent, share strains of their viruses in order to develop that year's influenza vaccine. In this year, instead of just handing over the virus strains as expected (and pressured) the Indonesian Minister of Health asked that x number of doses of the vaccine go to Indonesia (to vaccinate healthcare workers, the vulnerable, etc.). They were told "No, there are no more vaccine doses - they have already been reserved/purchased by other parties." But Indonesia did not roll over. They demanded the same access to the vaccine which would not even exist without their contribution. The international community was quick to attack Indonesia, citing their actions as an aggressive threat to global health security when all they wanted was to be heard. This is just one example of how power dynamics have taken advantage of already disadvantaged populations and the manipulation of health as a strategy.

This has been a bit more text than I originally planned, and yet it still just barely scratches the surface of some really complex issues. If you made it through this quasi-lecture: kudos, and thank you! Sharing some of these thoughts with colleagues has already led to some really interesting conversations while driving down the country roads of Northern Ireland or sitting in a coffee shop connected to my university on Tavistock Place and I am very keen to have more of these conversations if you have any thoughts to share. Personally, thinking about the relationship between international development, globalization, and post-colonialism has raised many questions for me about the field I have long aspired to join. I am getting a bit of a taste of it right now as I complete my first week of fieldwork in Sierra Leone and hope to share a bit more about this experience (and maybe more musings on my career identity crisis) soon!

*Keller, R. (2006). Geographies of Power, Legacies of Mistrust: Colonial Medicine in the Global Present. Historical Geography, 34, pp.26-48.

**Fanon, F. (1965). Medicine and Colonialism. In: A Dying Colonialism. New York: Grove, pp.121-145.

***Enria, L., Lees, S., Smout, E., Mooney, T., Tengbeh, A., Leigh, B., Greenwood, B., Watson-Jones, D. and Larson, H. (2016). Power, fairness and trust: understanding and engaging with vaccine trial participants and communities in the setting up the EBOVAC-Salone vaccine trial in Sierra Leone. BMC Public Health, [online] 16(1). Available at: http://europepmc.org/articles/PMC5100248 [Accessed 4 Apr. 2018].