Vinh-Kim Nguyen's "Republic of Therapy"

This is the third of my required response papers to the texts I've been reading for my "History of Health and Healing in Africa" class at Portland State. I signed up for the class without knowing what to expect because, frankly, I knew next to nothing about sub-Saharan Africa at the time. Oh, I knew something of the continent's colonial past and the rise of its various strongmen and dictators who have ruled over the years, and of course apartheid held a certain fascination for me as an American since our own legacy of human rights abuses is well-known, despite the denials of certain members of the jingoistic mob.

What follows is a response to Vinh-Kim Nguyen's "The Republic of Therapy: Triage and Sovereignty in the Time of Aids." Nguyen was one of the first Western physicians to work in Cote d'Ivoire after the severity of the AIDS crisis escalated there in the early nineties. He teaches and practices in Montreal, but he did his time on the front lines in the battle against AIDS, and this is his well-told story.

There are lessons in this story that reflect on America's stratified health system as well, but I'll not get into that now. My paper--

Death by Neglect: The Tragedy of Early AIDS Therapeutics in West Africa

Fewer people are dying of AIDS in Cote d’Ivoire today than did a decade ago, and the struggle for survival is marked by heroism. But given the known efficacy of “AIDS cocktails” since the mid-nineties, the powerless, even the unafflicted, must face the tragedy of what transpired early on, when failed policy initiatives, greed, and the economic hegemony of the West overtly influenced who lived and who died in West Africa.

The collapse of Cote d’Ivoire’s educational and economic systems in the 1980s generated “technologies of the self,” coping mechanisms resulting from the slow response of the world community to the West Africa nation’s poverty in the time of AIDS (Nguyen, Ch. 2, 6). Nguyen has linked the limited success of early HIV/AIDS therapeutics in Cote d’Ivoire to the “unintended consequences” of globalization and the policies of the World Bank’s neoliberal insistence on the privatization of nearly every sector of the nation’s economy as a pre-condition to ensuring developmental loans. The World Bank’s demands, premised on the notion that competitively-winning structural economics might naturally follow, proved disastrous as the nation plunged into poverty and debt in the 1980s and the divide between the haves and the have-nots widened. By the 1990s the poor and sick were paying the price in a barren environment of underfunded therapeutics, corporate (pharmaceutical companies) control, and NGO aid responses reliant on limited resources (Nguyen, Ch. 6).

The economic hegemony of the World Bank helped create conditions unsuitable to battling HIV/AIDS vis-a-vis its politicalized ideology of privatization. The “republic of therapy” in the author’s title suggests the shift of sovereignty from Cote d’Ivoire state to the boardrooms of “Big Pharma,” with NGOs from many locales competing for the limited resources of a donor-dependent fight against HIV/AIDS. Economic coercion strapped the Cote d’Ivoire government to its debt, limiting the depth of its own reaction to the health crisis, which intensified as the population’s poverty and numbers of sick grew (Nguyen, Ch. 6).

In effect, what remained for Ivoirians as the health crises blossomed was the power of the self and “communication technologies,” which Nguyen elucidates by referencing the theories of Foucault to examine how people respond as individuals in group environments, how leadership emerges and evolves, and how hierarchies are created from the energy borne of group dynamics. Therein lies another aspect of the author’s research—that sovereignty not only passed to corporations and NGOs in the early fight against HIV/AIDS, but also to individuals scrambling—literally—to survive in the face of limited drug trials and self-help opportunities. Necessarily, there were few winners in the scramble (Nguyen, Ch. 2).

Nguyen asks us to not paint a rosy picture of individualized sovereignty, for it created a subset of social problems within therapeutic groups, and of course was never the optimal way to fight AIDS. The author is just as clear that the corporatized/donor method of therapeutics was faulty. It follows that political policy as well as the NGOs’ dependence on the teats of foundations and ultra-rich donors did, if not sanction murder, at the very least create conditions for death by neglect in the initial fight against AIDS.

Source

Nguyen, Vinh-Kim, The Republic of Therapy: Triage and Sovereignty in West Africa’s Time of AIDS, Duke University Press, 2010.

TS

U.S. Bank Robbery

As if more evidence need be offered of the class war that is making the good old USA such a bitch, I cite a letter I received from US Bank regarding my meager checking account:

"On July 24th, your checking account ending xxxx will transition to a U.S. Bank Easy Checking account. The monthly maintenance fee for this is $6.95 with online statements or $8.95 with paper statements."

Mind you, my checking account with U.S. has been free for the past 20 years. Now all of a sudden things are going to be "easy?"

I scoff...

The letter goes on to explain how this robbery can be avoided by depositing more money per month and keeping a floating balance above a set figure. Being on a fixed income at the moment, neither option is available to me.

This hokey missive then describes some of the new "benefits" I'll have by participating in the rape. Mind you, nothing at all is new as service except the fee/robbery.

Like the color-coded scale of "terrorist threat," the bank is offering new and improved "packages." They are Silver, Gold, Platinum."

Whoopie!!

All of which is to say, RIP Gil Scott-Heron. You'll be missed.



TS

Planning Ahead

I'm looking ahead to the end of spring term, the end of my run at a formal education (is that the right expression?) at PSU, and the beginning of something new--namely working with Charles Deemer as we prepare his new book of poetry for publication here at RBP. This is terribly exciting, a big move for the press, and something I've wanted to do for months now, i.e, find other writers who can help carry the legacy of RBP forward.

I've published two fine books by K.C. Bacon (see sidebar). With Deemer's "In My Old Age" and whatever else I can find in my lifetime added to the mix...well, let's just say I plan on leaving something behind. History will give it meaning if it is worthwhile.

In addition, I want to begin work in earnest on my second memoir. I've been writing it in my head for months now; it's time to commit it to paper.

Charles, an adjunct professor of screenwriting at PSU, is a busy man himself, but prolific in the poetry realm of late. He's on record saying he doesn't write poems. They come through him (or somesuch), which is what honest poets say.

I like this recent piece considering the weather.

Don't know if it'll make Deemer's final cut, but there is plenty more where that came from. I expect a mid-summer publication date, so stay tuned.


TS

Heart of Loneliness

The following are two essays I've recently submitted in my class on the history of health and healing in Africa. As I've recently more or less ignored this blog, with infrequent posts, I have been engaged in this final class to earn my undergraduate degree in history at Portland State. It has commanded a lot of my attention with a great deal of reading and rigorous analysis of the texts.

From the "For What It's Worth" Department here at Round Bend Press:


Heart of Loneliness: Love, Migration and Sexuality in Postwar Bechuanaland

Fissures in Botswana society resulting from colonial, industrial and economic influences created new conditions of loneliness among Batswana in the post-World War II era. A heart of loneliness displaced old paradigms of community as a new morality filled the vacuum created by migration, debility and disaffiliation. As social conditions changed, a re-evaluation of relationships and a new meaning of love between men and women arose from nascent alienation. The moral imagination of Batswana stretched into new territory.

By 1960, 20,000 Tswana men were working for wages in mines, having left the merafe of southeastern Bechuanaland to toil in South Africa. Another significant number of workers—men and women—joined the flow of migration, seeking alternative wage work where they could find it, often far from the merafe and the familiarity of their old communities (Julie Livingston, p. 145).

Love in the time of migration became skewed. Amid new moral and physical landscapes, many men and women searched for each other in their hearts. As the influences of the gerontocracy and the chiefs/rulers of their culture eroded, they struck out on their own. While the essence of the heart (bopelo), a cosmological reckoning steeped in the merafe and the quest for purity and ancestral pacification remained strong for a time, as did the habit of cultural deference to elders, conditions were inevitably altered in the face of an emerging economy of individualism. Where men and women once lived and slept with each other in environments that promoted mutual understanding amid Tswana rituals, suspicions, worry, and dread (and attendant legal issues) arose in unions fragmented by space and time and the erosion of familial and sexual rituals. Men and women began to “break the rules.”

The heart of loneliness brought attendant problems to the social framework of Bechuanaland. Livingston refers to Lynn Thomas’ research in Kenya, where similar paradigm shifts opened Kenyan society to new levels of disaffiliation in the colonial era, resulting in a surge of unplanned pregnancies, abortions, and infidelity. The new order and evolving worldview of many young Kenyans was as much an effort to “create something new” as it was a reaction to the floundering of the old order, the author quotes Thomas (Livingston, p. 144). Livingston aptly applies this phenomenon to her own research in Botswana, finding causal similarities in the two cultures.

New levels of anxiety and alienation grew attached to personhood among Batswana in the postwar era through Independence. One is able to infer from the stark spike in mental health issues in the postwar era that men and women were suffering from more than debilities arising from war, industrialism and the economic abuses of the colonial system; they were also suffering in the realm of love. The heart of loneliness grasped them with an increasingly westernized discomfiture. As it happened, love did not so much fall apart as it rather grew irrevocably into something new and daunting in the Tswana psyche.

Livingston, Julie. Debility and the Moral Imagination in Botswana, Indiana University Press, 2005

I highly recommend the above work if you have the slightest interest in African culture and the impact of colonial rule in the twentieth century. It is a challenging and deep-seeded work by a brilliant historian. Despite its depth, or perhaps because of it, it is a remarkable read.

This second essay is on Lynn Thomas' "Politics of the Womb: Women, Reproduction, and the State in Kenya. While it is not as readable as Livingston's book, it remains fascinating for its discussion of female circumcision as a cultural phenomenon in parts of Africa.

Entangled Meru, Entangled Methodologies

An incursive interpretation of Meru historiography shapes Thomas’s analyses of native gender and generational disaffiliation, and British political and religious influence in central Kenya during the colonial era. Thomas attacks patriarchy with subtle precision. She deftly eschews teleology in her analyses by dissecting common entanglements between integrated colonial and Meru cultures that restricted the power of Meru women, demonstrating how colonial and localized patriarchal authority undermined these women.

Anti-colonial resistance as a major element of change in Meru is thus given short shrift in the author’s understanding of the conditions that led to upheaval in Kenyan society as well as independence, as if to say in bold lettering, Cold War? What Cold War? Social and cultural entanglement, Thomas argues, is the most important aspect of the historiography in question. It is a narrow focus, but deep in meaning. The author paints entanglement as the tension wrought between the expectations of a pre-colonial Meru culture once engaged in ordinary acts of living against the encroachment of a westernized ethos based in classist, racist, sexist and generalized assumptions of reality. Much textual evidence of these historical markers exists. Thomas isn’t concerned with it.

Vaginas, not philology, formulate her dialecticism as she graphs how both the colonizing and subjugated cultures grew entangled over time through laws and policies regulating women’s bodies. These discredited regulations stranded colonists in an imbroglio of complex social problems they were unwilling to admit--or were unaware--they themselves created. Analyzing this mélange, Thomas develops the post-modernist’s array of precepts. She throws off genre interpretations of anti-colonial rebellion steeped in the nuances of political and revolutionary fervor in favor of a deeper, incursive analysis of patriarchy as it played out in the collusion of colonial and localized Meru interests. Her research demonstrates again and again the fallacy of a black and white, East versus West, interpretation of Meru historiography. The core of the author’s argument synthesizes imperial and localized patriarchy, and for good reason, for she claims it led to myriad abuses of young women. But her argument is just as intent upon demonstrating that Meru’s historiography is unwieldy, and that teleological and anti-colonial messaging based in ideology are problematic.

Thomas, Lynn. Politics of the Womb: Women, Reproduction, and the State in Kenya, University of California Press, 2003.

Thanks for reading.


TS

Posting

I'm having a hard time with Blogger for some reason. Can't space paragraphs the way I want them.

It's really frustrating and turning into more work than I'm prepared to do just to post a few thoughts.

TS

Illness, Africa, Cinema

I have a yearly sickness thing going on. Last year at this time I went through a two-week period of general ill-health and discomfort. Since childhood, I've had sinus cavity issues. When I get congested and the snot begins to flow, it flows like the Amazon.

I'm having my yearly attack, but at least the feverish light-headedness has dissipated somewhat, which is not to claim I'm now all of a sudden clear-headed. That has never been the case, even in my young and vigorous times.

I'm taking a history course at Portland State, wrapping up a final class to earn a history degree at that fine university. Being sick and debilitated myself lately hasn't made reading about the long suffering of Africans any easier. The class is an overview of health issues in numerous African nations from colonial times through the HIV/AIDS crisis of today.

Twenty-percent of the citizens of Gaborone in Botswana are HIV/AIDS infected. Imagine that.

One thing that brings me succor even in these brutal times--I watch many movies. I've been on a kick lately, eyeing the monitor between sneezing and coughing bouts. I've revisited a few of my favorites and been catching up on a generation or two of films that I somehow avoided or missed in my slavish devotion to reading and watching sports from the 70s to the present.

A partial list of a few I've caught lately, in no particular order:

The Last Detail

Au Revoir Les Enfants

Endgame

Nowhere in Africa

The Interpreter

Insomnia

The Discreet Charm of the Bourgeoisie

The Big Lebowski

Battle for Warsaw

A Prophet

Athens, GA: Inside Out

Once Upon a Time in America

Army of Crime

Carlos: Miniseries

Letters from Iwo Jima

The Battle of Algiers

The Man Who Wasn't There

Platoon

Trumbo

Fargo

Restrepo

Defiance

See how sick I've been? Unless you're spending a lot of time in bed, too discomforted to sleep, bored with your own sad state of affairs, it would be impossible to watch all these films without feeling guilty.

TS

Kenneth Patchen

"The Way Men Live Is a Lie"

The way men live is a lie.
I say that I get so goddamned sick
Of all these pigs rooting at each other's asses
To get a bloodstained dollar-Why don't
You stop this senseless horror! this meaningless
Butchery of one another! Why don't you at least
Wash your hands of it!

There is only one truth in the world:
Until we learn to love our neighbor,
there will be no life for anyone.

The man who says, "I don't believe in war,
But after all somebody must protect us"-
Is obviously a fool-and a liar.
Is this so hard to understand!
That who supports murder, is a murderer?
That who destroys his fellow, destroys himself?

Force cannot be overthrown by force;
To hate any man is to despair of every man:
Evil breeds evil-the rest is a lie!

There is only one power that can save the world-
And that is the power of our love for all men everywhere.

Kenneth Patchen

TS