Towards Communicative Justice in Health

ABSTRACT

This article approaches care from a different angle by looking ethnographically at how it is shaped by structural differences in the power to control the circulation of knowledge. I focus on an investigation conducted by people classified as “indigenous”, of an epidemic that killed 38 children and young adults in a Venezuelan rainforest. I trace how health/communicative inequities structured clinical interactions, documents, epidemiological investigations, news stories, and dialogues with healers, thwarting the identification of the epidemic, clinically identified as rabies. Although the Bolivarian socialist government provided access to care, professionals denigrated parents’ contributions to care and communication and reduced complex, unequal relations between languages to practical problems of translation. Pointing to parallels with US social movements, I suggest that responding to demands for communicative justice in health requires seeing how health inequities are entangled with health/communicative inequities. The typographical slash points to importance of challenging the subdisciplinary boundary-work that relegates their study to non-overlapping conversations in medical and linguistic anthropology.

KEYWORDS:

• Epidemics
• health inequalities
• indigenous health
• linguistic anthropology
• rabies

Acknowledgments

I thank Odilia Torres and Romer Torres and the other parents for making me a part of their struggle for justice, and the other members of the team—Clara Mantini-Briggs, Conrado Moraleda, Enrique Moraleda, Norbelys Gómez, and the late Tirso Gómez—for their contributions to conceptualizing these issues and revealing their importance. I presented versions of this article while a Lichtenberg-Kolleg Fellow at the Georg-August University of Göttingen. Vincanne Adams, Mark Nichter, and Howard Waitzkin critiqued an initial draft, Elizabeth Roberts inspired me to see it through to publication, and two anonymous reviewers for Medical Anthropology provided splendid suggestions.

Funding

The investigation organized by the Moraledas was supported by funds from the School for Advanced Research’s J. I. Staley Prize, and the Latin American Studies Association’s Bryce Wood Book Award, and book royalties for Stories in the Time of Cholera. A research grant from the Salus Mundi Foundation permitted a return trip in 2009. A Weatherhead Fellowship from the School for Advanced Research enabled me to begin writing about the epidemic.

Notes

^1. See also Nichter (2008), Nichter and Kamat (1998), and Trostle (1998) on notions of “self-medication.”.

^2. As Marisol de la Cadena (2015) suggests, such categories are tricky, invoking a range of powerful binaries.

^3. For a detailed discussion of the epidemic, see Briggs and Mantini-Briggs (2016).

^4. This information was provided in an ‘Informe (Report) dated February 6, 2008, by the Regional Epidemiologist, Delta Amacuro State.

^5. Regional Epidemiologist, Informe, p. 3.

^6. Coordinación de Epidemiología, [Misión Barrio Adentro], Estado Delta Amacuro, Informe preliminar de visita a la Comunidad de Mukoboina, September 20, 2007.

^7. See for example Nossiter (2014).

^8. For examples of this large body of literature, see Hill (2008), Perry and Delpit (1998), Woolard (1989), and Zentella (2003).

Additional information

Funding

The investigation organized by the Moraledas was supported by funds from the School for Advanced Research’s J. I. Staley Prize, and the Latin American Studies Association’s Bryce Wood Book Award, and book royalties for Stories in the Time of Cholera. A research grant from the Salus Mundi Foundation permitted a return trip in 2009. A Weatherhead Fellowship from the School for Advanced Research enabled me to begin writing about the epidemic.

Notes on contributors

Charles L. Briggs

Charles L. Briggs teaches in the Department of Anthropology at the University of California, Berkeley. He researches health, communicative practices, media, poetics, indigeneity, social justice, and their complex interrelations. His publications include Learning How to Ask; Voices of Modernity (with Richard Bauman); Stories in the Time of Cholera (with Clara Mantini-Briggs); Making Health Public: How News Coverage Is Remaking Media, Medicine, and Contemporary Life (with Daniel Hallin); and Tell Me Why My Children Died: Rabies, Indigenous Knowledge and Communicative Justice (with Clara Mantini-Briggs).