Cholera outbreak.

CHOLERA OUTBREAK Charles L Briggs with Clara Mantini-Briggs, Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare, University of California Press, 2003

Stories in the Time of Cholera chronicles the 1992 to 1993 cholera outbreak in the coastal Delta Amacuro state of Venezuela, which claimed hundreds of lives. Briggs, who wrote most of the book, is concerned with outlining and challenging the construction of indigenous peoples as the cause of the outbreak.

It is a book filled with stories of diarrhoea, vomit and severely dehydrated bodies. The lived experience of cholera is represented from the point of view of an anthropologist with a strong tie to the area (nine of Briggs' closest friends died in the early days of the epidemic) and a public health physician (Mantini-Briggs) who assisted in clinics on the frontline, receiving canoe-loads of dying people hourly at the peak of the outbreak.

Briggs weaves together the voices of the media, which largely reflected official narratives of the epidemic, and stories told by Warao (indigenous people from the Delta Amacuro area) immediately after the outbreak, and two years later. These voices map onto two opposing narratives: cholera as a biomedical disease affecting indigenous and poor people because of their cultural practices; and as a disease exemplary of modernity, globalisation, and social inequality. His argument is that the second narrative is true, and the first is not only false, but masks the racialised oppression of indigenous people.

The tropes of poverty, primitiveness, marginality, lack of education and filth circulated freely in the early nineties as the South American cholera epidemic began in Peru. Cause and effect were reversed in a familiar 'blame the victim' repositioning. In one example, workers buying food from street vendors are blamed for spreading the disease, while in reality, it is globalisation and government policies that force them to work longer hours and commute further, obliging them to sustain themselves on vendor food.

Narratives from those with cholera work to deflect attention from the rudimentary sanitation facilities provided for indigenous Venezuelans, focusing on constructions of their poor hygiene, eating habits, ignorance and fear of Western medicine--that is, their 'culture'. At stake was nothing less than the nation's economic survival (such as fears for the tourist industry) and, even more crucial, its claim of inclusion in modernity.

Briggs introduces two main terms to describe the technology of cholera-related oppression. The notion of sanitary citizenship builds on work in anthropology and political science that explores the apparent tension between the promises of modern citizenship and the reality of racial, gender and other inequalities. This tension is resolved by states in the selective designation of citizenship. Thus indigenous people who suffer from cholera are not citizens of the state who have been denied their human right of effective health care. Rather, by the very act of being disadvantaged, they show they are suspect citizens. The term medical profiling, though not as clearly defined in its use in the book, seems to be the process by which medical care is dispensed along racial lines, and thus how un/sanitary citizens are created.

There is a great deal of material presented in this book. From the World Health Organisation to the Venezuelan public health bureaucracy to staff in remote clinics, Briggs expertly tracks the institutional lines of responsibility that created official accounts of the epidemic largely reproduced by the media. In contrast, Chapter 10 presents Warao narratives of the epidemic that link cholera with Columbus, the US invasion of Iraq, marine pollution and angry ancestral spirits.

He persuasively shows that racialised narratives pinned the epidemic on the Warao from the very start, and sabotaged even the most blatant shows of political resistance. However, in his passionate belief of their ongoing oppression, he appears at times to undermine their agency himself. For instance, in chapter 13, he describes how two particular indigenous people were featured in the media 'constantly' as spokespeople for the Warao. But in the next breath, he appears to contradict himself: 'Delta residents were unable to get their cholera narratives into the media, where biomedical and institutional voices were privileged' (305). Do Warao have a voice in the media or don't they? He may mean by this second statement that the two Warao who were featured in the press were no longer 'Delta residents' (but were based in the regional town). However, this is suspicious of a downplaying of the voice of the Warao that does exist, if only via two Spanish-speaking representatives.

Clearly, the political agenda of this text is to place the blame for the epidemic on the government, and to reveal the blaming of the Warao as a manifestation of the racist oppression of indigenous peoples. In this he succeeds. He almost succeeds too much, and I suspect his political prism may be obscuring how the Warao do make deft political moves that achieve something. For example, his claim in Chapter 7 that a political demonstration held by the Warao had no effect because it was interpreted by the press as 'Indigenous people begging' is unconvincing, particularly as in Chapter 5 he has described similar indigenous political protests without rejecting their efficacy.

The project of this book is quite clear: 'Achieving social justice' is the final subheading of the final chapter, and the profits from the sale of the book, we are told, will further the authors in assisting Delta Amacuro residents in their ongoing struggles for health and justice. It will greatly appeal to those attracted to a brand of scholarly activism, or those drawn to the content, but may not live up to the expectations of those looking for a more nuanced theoretical perspective on modern political struggle.

DR EMMA KOWAL

Centre for the Study of Health &

Society

Berkeley University of California