Wednesday, January 30, 2013

Only brown people shit

Have you ever noticed the great lengths that people go to conceal bodies and bodily acts in the US? Restrooms are hidden in difficult to find places and signage isn’t necessarily apparent. Two sets of doors (one right after another, creating a hallway) prevents outsiders from catching a glimpse of the inside. Sanitary products are scented to prevent revealing odors. Scented candles and potpourri in private restrooms conceal the activities of the previous occupant. Even news stories talking about obesity blur out the faces of people they show images of, even if the bodies on display are in “public” mode (ie, walking down the street just normally).
A picture from a channel 10 news article on obesity. Notice how the faces are carefully left out.
My point, rather unsurprisingly, is that we have a lot of anxiety about our own bodies and bodily actions. You won’t see depictions of people defecating in mainstream discussions, unless it’s for comical effect, shock value, or to point out their uncivilized behavior and deviant status (as in covering a news story of someone defecating on a police car in protest). We won’t even talk about it, unless it’s about infants or social deviants.
Contrast all that with this video from CNN, where the camera shows (quite clearly) people defecating on the railroad tracks. Their bottoms are blurred, but not their faces, protecting the viewer’s sensibility, but the not the anonymity or dignity of the people being photographed. You can find countless pictures of people defecating on blogs, news outlets, videos, and other visual media, but what do the people have in common?
1)      They are all men or children..
2)      They are all visibly impoverished people in developing countries.
3)      They are not blurred out.
(I don’t really want to go and find more examples for you all, but spend some time with Google and YouTube and you’ll come across more examples than you care to see.)
It is the bodily actions of the poor, racialized Other that can be on display, not our own, and certainly not women’s. The bodies of the Other are fair game for display. In their bodily practices we can see enacted their deviance from the norm. We can see their alien-ness. Their inferiority. Their dirtiness.
People might argue that it doesn’t matter to the people being photographed. These are people who are so poor that they can’t afford toilets—it’s not like their neighbors will see these pictures, right? It’s not like potential employers will see these pictures, right? But in a country like India, where there are more cell phones than toilets, the interconnectivity of the Internet can exist side-by-side with a lack of sanitation. As my colleague and fellow graduate student Aubrey Graham has researched, the photos we take and how we take them in developing countries can come back to these countries and result in dire consequences—stigma, anger, and sometimes violence. While I cannot think of any particular specific incident in which a picture of someone openly defecating has directly affected that individual’s life, I think it is unfair and wrong to force that risk upon already marginalized people.
[The following section may contain some imagery that sensitive readers will find disturbing. Possible trigger warning.]
But much broader than that, such discourse harkens back to 18th and 19th century European fascination with the intimate bodies of the exotic peoples. Saartjie Baartman, a black South Afrikaan woman born in 1790, was a part of an exhibition that travelled throughout London and Paris for five years under the anglicized name Sarah Baartman.

Anatomical diagrams drawn after death

She was advertised as the “Hottentot Venus” by the animal trainer who showed her off. She would emerge from a cage on a raised platform, where people would poke at her and wonder at the strangeness of her shape, wondering if her buttocks could be real. She was seen as hyper-sexual, as animal, and as not human.
French print from early 19th century: "La Belle Hottentot"
European observers say, "Oh God Damn, what roast beef!" and "How comical is nature!"
After her death, the French anatomist George Leopold Cuvier (1769-1832) examined her body in great detail. In particular, he was very interested in her genitalia, convinced that he would find anatomical evidence showing how she was naturally lascivious and animalistically passionate. Through his measurements, he claimed to find fundamental differences in her genitalia, and his examination of her came to stand in as the definitive study of all African women. He then proceeded to remove her genitalia, preserve them, and put them on display in the Museum of Man in Paris. Beverly Guy-Sheftall writes of this, “There is nothing sacred about Black women’s bodies, in other words. They are not off-limits, untouchable, or unseeable.” This is in contrast to the bodies of white people, and especially, white women.
Many of the chapters in Jennifer Terry and Jacqueline Urla’s book Deviant Bodies demonstrate the urge of European men to find explanations for or proof of social deviance in the bodies of those who society deemed deviant—prostitutes, nymphomaniacs, Black people, criminals. There must be something in the bodies of these people who explain their strangeness, how they are biologically (and thus, in their view, fundamentally) different than me: the size of the labia, the shape and size of the brain, and, in modern times, their very DNA. By rendering the differences biological, we render them safe—I cannot possibly be like that.
But I would argue that in the visual depictions of sanitation and defecating we are doing the same thing but instead of looking at the body directly as the source of abnormality and otherness, we look at practices of the body—which, really, are still very close to the body itself. Like Sarah Baartman’s genitalia, we can place the body practices of the Other in our modern museums—the images of the media. By visually depicting these bodily practices, we distance ourselves from them, dehumanize them, and, under the guise of sympathy, ensure ourselves that we are not them, that they are fundamentally different than us.
This has a tendency in manifesting in policies and programs that seem to be based on the idea that somehow people who are openly defecating or engage in bodily practices that are different than our norms are different in some way, that what motivates them are strange “cultural” reasons that we must decode. “Culture” becomes “body”, since it is not accepted anymore (most of the time, anyway) to talk about fundamental “biological” differences.
So as we fight for better sanitation coverage in the world, it is important to think of how we do it. What are the stories we tell with the pictures we take? And do we want those stories told about us?

Saturday, January 12, 2013

Chasing polio: Is eradication the right goal?

Last week, I discussed some of the aspects of the disease of polio and the history of the eradication campaign after the recent deaths of aid workers in Palestine prompted people to examine the campaign.

So, should polio be a global health priority?

Very few people die of polio. Very few (relatively) actually show any signs of polio. While the symptoms can be very dramatic and heart-wrenching, they are not common. I am not diminishing the suffering of those who are afflicted. But as I previously pointed out, so few people are actually afflicted.

Compare the number of people with polio to the number of people who die from just plain, old, standard diarrhea. While it’s difficult to measure (since it’s difficult to classify whether it’s ‘diarrhea’ or ‘bad day’), WHO estimates there are approximately 2 billion cases of diarrhea every year. 1.5 million children die every year of just diarrhea. It’s the number two killer of children under five (second to respiratory illness), and costs countries millions of dollars every year in healthcare and lost man hours. Vaccines do not address any of this. Sanitation does. Instead of spending vast quantities of social and financial capital trying to eradicate a disease that is not that fatal, perhaps the resources are better spent addressing larger structural inequalities that create these huge differences.

Do I sound like a broken record? Probably. Sanitation is important, and polio is another disease that emphasizes this. Structural methods, such as sanitation and water infrastructure, are more difficult, complex, and expensive to implement, and it is so much more difficult to tally the lives saved. Yet these sorts of long-term solutions are the way to make long-term, significant, and sustainable solutions to health problems.

Yet, if we give up, what is risked? There is the fear that if people give up on the polio campaign, then donor agencies will see the money as wasted, that these groups (whether governmental or nongovernmental) have given up and are not worthy of more funds in the future. There is a sense that enough money has been sunk into polio, that we need to keep spending or none of it will have been worth it. We like eradication. We like checking diseases off of our list, and we don’t get to do that very often. And yet, with the speed that diseases evolve and that people reproduce, we may have to face the fact that eradication is not the right goal. Instead, we should focus on improving whatever health issue is the most salient in the particular community.

~Public health priorities is an incredibly complex topic, and I have only just started to scratch the surface. For more information on polio in Pakistan and global health institution culture and politics, check out Svea Closser’s book Chasing Polio in Pakistan.

Sunday, January 6, 2013

Polio in Pakistan: challenges of and to eradication

In the past month, aid workers in Pakistan have been targeted by the Taliban. Six workers were killed in December and another seven were killed this past week in what is becoming a pattern of violence against polio vaccine workers in the country. According to the NPR articles, Pakistani militants have accused the vaccine program of being a Western plot to sterilize Muslim children. The CIA's use of immunization workers to uncover the location of Osama bin Laden increased hostility to the campaign. In response to the December shootings, the UN withdrew from participating in Pakistan's vaccination program, citing safety.

Polio is high on the target list for disease eradication. Smallpox is the only infectious disease that the world has successfully eradicated, and since that success--the world-wide outpouring of effort that resulted in smallpox being banished to lab experiments--other NGOs and health groups continue to dangle the goal of eradication in order to gain support for their cause. Gates Foundation has targeted malaria. Carter Center targets trachoma and guinea worm. Rockefeller Institute took up hookworm. And Rotary International has taken up the cause of polio.

What exactly is polio? Polio, or poliomyelitis, is a virus that enters the mouth and nose through contact with infected mucus, phlegm or feces and breeds in the throat and intestinal tract. It becomes absorbed into the blood and lymph systems where it incubates from anywhere from 5-35 days (one to two weeks on average) before symptoms might show. Most people, however, never show any symptoms, but they can still transmit the disease. Of those who do have symptomatic polio, most will only show mild symptoms. These include what you might expect from almost any mild flu: fever, sore throat, headache, vomiting. These will generally pass in a few days.

The polio that inspires so much work and fear and images of crippled children is when the poliomyelitis affects the central nervous system (brain and spinal cord). From there, polio causes paralysis, resulting in a lifelong problems with mobility and social stigma. (Most commonly, this paralysis affects the legs, but a relatively small percentage will die from the.) However, fewer than 1% of people who contract polio suffer from paralysis. Clinical polio, while tragic, is only fatal when it paralyzes the respiratory system, which occurs in 5-10% of the paralysis cases.

In the late 1940s and early 1950s, polio crippled almost 35,000 people a year in the United States. After Jonas Salk discovered a vaccine, the response was immediate and swift. Pictures of little girls in metal braces and crutches flooded media, urging parents to get their children immunized. The campaign worked--the fear and panic that had plagued the American people had mobilized them in participating in a mass vaccine campaign, successfully eradicating polio from the US by 1979. (The last cases of polio were in isolated Amish communities.)

Jonas Salk discovered the vaccine most of the readers will be familiar with. Four shots in the arm or leg of inactivated polio vaccine (dead polio virus bodies). In countries such as the US, these shots are given at two months of age, four months, six to eighteen months, and a booster at 4-6 years of age, part of the standard set of immunizations which American children are often required to have before entering school.

Jonas Salk had a little-known competitor, however, an Albert Sabin, who worked at Cincinnati Children's Hospital. He developed another vaccine, which he viewed as superior. Unable to get support for it in the US, he went to the USSR during the Cold War and tested it there. Sabin's vaccine is oral, two drops in the mouth, and is what is used in most mass vaccination campaigns in developing countries such as Pakistan. It is simpler to use, and, because it doesn't require an injection, runs less risk of accidental infection from non-sterile conditions.

With the elimination of polio from the US, public health campaigns grabbed the narrative of "we have this immunity, let the rest of the world have it too" to fund the Polio Eradication Initiative, a twenty-year, six billion dollar project that has involved two million people, making it history's largest public health campaign. The progress has been incredible, with only Pakistan, Nigeria, and Afghanistan still reporting cases. However, the success is tenuous, with recent outbreaks in the DRC and Chad, and children being born every minute who need to be vaccinated to keep the disease in check.

We tend to conceive of polio vaccination as being a simple four part program. But in places like Pakistan and India, ten or more doses of the vaccine spaced a month apart are required to confer immunity on a child. Poliomyelitis thrives in warm places with high population densities and poor sanitation--in other words, India and Pakistan. Svea Closser, author of the book, Chasing Polio in Pakistan: Why the World's Largest Public Health May Fail, writes:

"In 2006, surveillance data showed that in 93% of districts in Pakistan, the median number of OPV [the oral vaccine] doses that children under five had received was more than 7; it was more than three in 99 percent of districts. Put simply, if immunity to polio required, as in the United States, only three doses of vaccine, poliovirus would have already been eliminated in Pakistan."

To get the ten or more doses into every child is an incredible feat, with a lot of challenges. Next week, I draw on Svea Closser's ethnography to examine the challenges and the assumptions of polio eradication, and I'll speak some public health heresy and ask, Is it worth it?


Tuesday, January 1, 2013

Happy New Years and my top 5 posts from 2012

Happy New Years everyone! It's back to Atlanta and back to blogging. I hope you guys had a great holiday season.
It's hard for me to take a few days off of work and study. I keep seeing things that inadvertendly remind me of work.
My boyfriend and I went to Disneyland over the break, and I couldn't help but notice that not only was the women's restroom poorly designed, but really should have had low-flush toilets. It is southern California, after all, and water is one of our most precious resources.
But between the poop jokes at my research (I think an inevitable part of my life now, thanks to my research), I managed to take a few days off and relax, and am now ready to attack the new year like a caffeinated cheetah! (Ok, maybe not yet. Give me a few days to recover from New Year's Eve.)
It's been a lot of fun blogging this past year, and I've been really flattered at the positive response. I'm trying to get back into the swing of things back here in Atlanta, so I've decided to be a bit lazy and jump on the "looking back on 2012 list" bandwagon. Here's a look at my top 5:
1. By FAR, my post, "How the Romans wiped: the history of toilet paper part 1," has been the most popular of all my posts. (Check out part two here!) I guess we're all a bit curious about these things. I also can't help but cringe when I think of the Roman sponge sticks.  
2. My post on Code Red! an app for that time of the month seemed to strike a cord with a lot of my readers, especially my female ones. Public restrooms are perhaps one of the most evident ways in which inequality is literally physically constructed in the world.
3. I was a bit surprised at the popularity of my post on airplane bathrooms that I wrote back in July. I guess there is something rather mysterious about the airplane toilet. After a 27-hour plane ride, I had fun scouring the internet to figure out how it all works.
4. From the annals of weird academic studies, this post, "The urinal next to yours: an actual academic study," discusses a psychology experiment in which the scientists used a periscope hidden in a stack of books to examine how long it took someone to start urinating when someone was using the urinal next to theirs. Incidentally, I came upon this study as an example of "studies that won't pass the ethics board anymore."
5. This post, "Sit or squat?", engages in the debate over which is healthier. I've loved how people have responded--I've even had friends tell me that they're half-way tempted to install a squat toilet in their own home. (I know I want one.)
So thanks for reading, commenting, submitting, or chatting!

Join me sometime within the next week when I discuss polio in Pakistan, and how the polio vaccine works when you're not in the US.