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