My Little Buttercup, Or what happened when I visited a community health center near Bo

I wanted to see a community health center, where clinicians might have seen suspected Ebola cases three years ago. So, I asked my driver, Idrissa, whether he could ask some of his local contacts about the location of the health center in Gondama. I hadn’t been to Gondama since 2003. It wasn’t too difficult to get to, we knew. I had, in fact, seen a sign for the place when we were driving elsewhere. So, on Wednesday morning, we drove over a weather pitted road to the health center. When we arrived, a guard opened the gate to the modest facility. At least a half dozen men and a few women were in the waiting area.

Odd, I thought. My experience was that women tended to go to health centers, but not a lot of men – not because men don’t get sick or hate health centers, but because women and children are often the target of community health interventions (but that is another discussion for another day).

Two women greeted me, and nodding toward the group of men and women in the waiting area, told me that the community health workers (CHWs, they called them) were all there, ready.

Odd, I thought. Impolitic as it was to think or say, I didn’t really care about CHWs. Not today. But I did ask whether there were any female CHWs because, judging from the small group gathered, there didn’t appear to be any. “Yes, there are women there,” they said almost indignantly. I corrected myself and asked sheepishly, “But are there more men than women, or about the same number of both?” They laughed – more like harrumphed – and told me, “Well, it’s not 50-50,” a reference not to an actual ratio, but the way gender parity was often discussed colloquially in Sierra Leone’s development industry.

I followed the women – I’ll call them Amie and Fati – into an office where we sat at a table. The small room was crowded with furniture, and the walls were covered, predictably, with posters from the ministry of health related to women and children’s health. They began to interrogate me about what I wanted to know, and asked me if I wanted to look at their rosters, and when I would be talking to the CHWs who had gathered to meet me. The CHWs had been waiting and were becoming impatient.

Then it occurred to me: they thought I was someone else! (The reference in the title of this post is to that mistaken identity scene from Three Amigos, if you hadn’t caught it). I told them, “I’m not here to meet with CHWs.” I told them that I was just around and happened to come to Gondama. I didn’t have any specific questions, really, but did they happen to see Ebola three years ago? Yes, but they referred them to the district hospital. Having been a consultant once upon a time, I mentioned that unlike a consultant, I was not interested in extracting information from their registers, their CHWs or them. I simply wanted to observe. Their eyes widened. But surely, I was from an NGO. Nope, I wasn’t. This kind of admission – that you had no NGO affiliation or specific agenda besides ‘observing’ — can make you seem unserious if not untrustworthy. Everyone has a mission, whether they admit to it or not.

The facility’s in-charge, as in most of the places I visited during this short, unannounced trip, had been called to Freetown for a meeting. Whatever his shortcomings, among them was that did not give them enough information about who would be visiting, their purpose, or even the time these inquiring strangers would be arriving. I suspected that their confession was a bit of shade towards their co-worker, but it was also some shade towards the process itself: people were coming all the time to gather information; strangers like me were interchangeable with each other. The logos on our white Land Cruisers could be swapped and they would be none the wiser; the stranger could be from Boston or Washington or London, Johannesburg or Nairobi. The source of the information to be extracted was a circle of gathered CHWs or maternal registers, or immunization charts mounted on the walls or…

“Won’t you come and look at our labor and delivery area?” asked Amie. Inside the maternity ward were a couple of midwives who asked me if I too was a midwife. I told them no, but I’m a mother of two. (No comparison, though. Their work can be rough). There were four or five padded tables separated by curtains and fitted with stirrups. In a separate room, there were a few beds for new mothers who would, after their deliveries, be discharged after 72 hours. On a wall near the entrance, I read the instructions about when to deliver oxytocin, and briefly recounted the induced delivery of my daughter five years ago. Then I told them about the worried look on my obstetrician’s face when she couldn’t stop the bleeding during my second delivery. I mentioned how my son’s heart rate began to decline rapidly, how I strained to block out any semblance of panic by pushing. “Eeeeeehhh,” they said almost in unison, sucking their teeth at the very real trauma of childbirth. But the boy was healthy and strong. I would have panicked for nothing. I reached for my phone. “Yu wan si mi pikin dem?” Yes, sure, they said. I showed them pictures of my babies. Then I gave them my card and said I’d be going so they could prepare for the real guest.

They wished me luck on my quest — whatever it was. I wished for them a not-too-much longer wait for the stranger who wanted to meet with the CHWs.

Politics and memory in the fever archive: A tribute to Rosalind Shaw

Here is the text for the talk I gave during a celebration of the work of Rosalind Shaw

Politics and memory in the fever archive

First, I need to apologize to the discussants and the audience.

Two things happened between the time I sent this already fragmented paper to Jean and Rosalind.

  1. I participated in a panel called “The Humanitarian In the Mirror,” which featured a cross-disciplinary discussion about humanitarian images, representation and whiteness. So the things I am going to say differ a bit from what I sent you last week.
  2. Immediately after that panel I went to the movies — this requires a celebration of grandmothers who are willing to watch a four-year old and an eight month old. I  saw the horror film, Get Out. So the apology to the audience is that this talk may contain some spoilers if you’re planning to see the movie.

From the panel in Baltimore, I met Catherine Mathers, an expert on student voluntourism and the racial politics and ethics of humanitarian representation. In her paper, she highlighted the role of parody, focusing specifically on Savior Barbie, and how such projects facilitate some degree of self-critique — specifically of whiteness and savior industry — without fundamentally challenging the unequal sociopolitical dynamics undergirding them. After seeing “Get Out,” I realized that a finer point to her argument, and she certainly confirmed this in a later twitter discussion,  is that a structural critique of whiteness, particularly today, requires a different narrative genre: not parody or satire — our most common fallback in this post-Colbert/White Savior Barbie era–BUT HORROR.

The film follows Chris Washington, a black photographer, as he travels with Rose, his white girlfriend (does she have a job?), to her family’s home in a wealthy white town (like the witch cities Rosalind describes in her work). He is warned by his close friend, Rod, a TSA agent, to not go on the trip, but Chris ignores his friend’s warning and finds himself the victim of a plot designed by whites to purchase and inhabit black bodies, which we ultimately learn is driven by their desire to appropriate and use what they perceive to be the most valuable elements of black life and existence.

Today, I want to read this insight alongside Rosalind’s body of work on politics and memory and my recollections of the Ebola outbreak in a book length essay entitled “The Fever Archive.” Some of you may recognize it as a play on Derrida’s Archive Fever, which I came to through my discussions with friend and mentor, Byron Good. I want to begin by telling you a bit about myself through recounting a bit about my parents, whom I also saw this past weekend, in South Carolina.

Searching for Mende-ness

During my visit to South Carolina, my father, an amateur genealogist and historian, and retired social worker, recounted his experience of his visit to Sierra Leone. His voice cracked under the residual strain of a mild stroke and congestive heart failure that put him in the hospital and through months of physical therapy last year. In many ways, I suspect dad’s long stories are a way for him to reckon with the possibility that he will eventually no longer be able to tell these stories, that the histories that he has foraged from the archives, his memories of the past, will vanish into the ether, never to be recovered.

I’m overcome by the exhaustion I hear in his voice but I hold my tongue about the choices he makes about his health: my father still drives himself 45 minutes to teach a course to young social workers at South Carolina State, a public historically black university in Orangeburg, South Carolina, where, nearly 50 years ago, patrolmen fired upon black students protesting segregated local businesses. My father’s weekly circular commutes to that place feels like a less grand return: it was his first landing spot upon his arrival from Seattle in the early 1960s to study ministry before he moved to Benedict College, in Columbia, SC, to complete a degree in sociology. The town is also one of the childhood homes of former republican South Carolina governor, and current US ambassador to the UN Nikki Haley. Her immigrant parents taught at another local historically black college when they arrived from India, and as I like to tell people, put her in a high school in Orangeburg, formed by white families who opposed desegregation — rituals of the past becoming institutionalized and embodied in figures who are held up by the current administration as evidence of “diversity.”

As Dara, my eight-month-old, cries in one of the bedrooms in the back of my parents’ house, my father has pulled out a couple of genealogy books, showing the migrations of his ancestors from Mississippi and Alabama, to Tennessee, Ohio and, later, to Washington state. A Seattleite born in Chattanooga, Tennessee, my father’s interest in the movements of his people had been a several decades long project. He pored over census records and consumed lay and academic historiography of the region, seeking not only origins, but also memories, which Rosalind has reminded us, are separate projects of reckoning with the past and with history, as it is embodied and experienced — as it lives in everyday social and cultural practices.

Dad stops to catch his breath. I jump in as he complains about tainted drinking water, and oversells the deliciousness of cold, crisp lagers like Star and Club. (They aren’t really that great). He reminisces about the winding bus route from Accra to Kumasi. His story quickly devolves into humorous accounts of intestinal upset, the embodied memory and experience of fevers and bodily discomfort that become an essential part of the story binding a certain class of fellow travelers. He detailed the sweats, shivers, shakes, and runs that indelibly shaped his bodily experience of moving through settings unknown, settings to which his body had no time to be accustomed: the two-week vacation does not allow one to sample and experience everyday life without consequence. Fever, chills, diarrhea, nausea, also become deep embodied memory of place.

In “Get Out,” Missy, Rose’s psychiatrist mom, sends Chris into his sunken place with the power of suggestion, and the faint tinkle of a silver spoon against a tea cup. We see a hypnotized Chris falling, descending into deep darkness, with nothing or no one to catch his fall. Law Ware describes the sunken place as a kind of “black collective unconscious wherein we hide our pain from ourselves.” Professor Christina Sharpe might call it the “hold” like that of a ship — a place that signifies and embodies both the life and afterlife of slavery.  In the process of extraction and appropriation of the black body by white, wealthy consumers at the parents’ yearly dinner party, it is the step before surgical “coagulation”, which Robert Johnson, Jr describes as “the inherent failure of integration, the danger it presents to black people and consciousness, and how proximity to whiteness…” may both divine some blessings (first configured as the relationship between Rose and Chris — or Chris and Rod, for that matter) but also the most “toxic of curses.”

Dara is still crying. My mom is with him, remarking on the old world knowledge passed down in her little segregation era village, called Britton’s Neck — the place with the dirt road named after Doc Taylor, the high school principal (her grandfather) who refused integration because of the damage it would do to black children and the quality of their education, leaving the Britton’s Neck School District — until recently, I believe — the smallest school district in the state of South Carolina. When my mother perused the census records to learn more about her mother’s childhood, she saw that this same principal grandfather had crossed out the racial classification of “Negro” and scrawled “African,” in its place. The US state project to erase African history and intimate connection between Africans and African Americans were captured in this minor act of refusal and reinscription, leaving a mark on how we came to understand my grandma Pauline’s revolutionary spirit and the continuity in feminist generations following.

During her visit to Sierra Leone, and armed with knowledge that she shares a genetic marker with Mende people in an African ancestry database, my mother searched for signs of the country in her childhood, in the way her parents and grandparents cultivated and ate their food (greens, sweet potatoes, and of course, rice — which we ate nearly every day in my childhood home). She wondered aloud about the names they called white people in their tight knit and all-black community — which sadly was not puu moi but buckra, which is said to be derived from an Efik word (mbaraka).

Ebola’s ethnographic archive

Angela Garcia has recently noted that it may be “productive for conceiving ethnography as a kind of archival endeavor that connects and unfolds affective, material, and temporal fields.” As I am listening to my father, brother and nephew go back and forth about the history of my mother’s people, a text from Paul Farmer, a mentor, old friend, and vocal admirer of Rosalind’s work, as if summoned by some ancestral spirit, pops up on my mobile phone. He needs a citation for something I’ve written. Paul knows all too well how the ethnographic archive — even when divorced from and no longer sheltered by the state or administered for use by the state — derives its value from/through a political economy of publication (making it (nominally) public), which includes increasing citation counts, mapping scholarly kin networks, and (viral) transmission and circulation of knowledge about the epidemic. In one of the pieces, Ebola’s Keywords, I wrote the following about the term “survivor” as it had been used throughout the outbreak. Here, I hope to draw on the conceptual connections suggested in its definitions, between property and what remains, between affect and kinship:

Survivor

person who survives, especially a person remaining alive after an event in which others have died.

1.1 The remainder of a group of people or things:

1.2 A person who copes well with difficulties in their life:

1.3 A joint tenant who has the right to the whole estate on the other’s death.

As Ebola treatment units expanded in late 2014 and early 2015, health workers from all over the world came to assist in caring for Ebola patients. Ebola interventions focused on clinical treatment as much as prevention, isolation, containment and “dignified death.” With this expansion of resources in the affected countries, the number of survivors increased, bringing down previous case fatality estimates from 90% to 30-40%.  A person was said to have “survived” Ebola once she had cleared the virus and recovered from the worst of the symptoms.

But it wasn’t until clinicians and epidemiologists saw a large number of survivors that they learned that surviving an acute Ebola infection was not necessarily the end of illness. Months after being declared “virus-free,” individuals who had been infected with Ebola continued to transmit the disease through sexual intercourse; others suffered from post-Ebola syndrome, a collection of symptoms related to Ebola infections: ophthalmological problems; musculoskeletal pain; hearing problems; and other neurological disorders.

There were other implications of having survived an Ebola infection. Survivors were said to have developed immunity to the disease, at least in the short term. This caused some speculation (in many senses of the word) about the value and use of survivors. Most of this discussion was centered on how to enlist and exploit their labor as caregivers and their biological material — serum developed from their blood, for example — whether their blood is a gift, purchased, or obtained in other ways. It is no accident that this discussion occurred within academic institutions, rather than in spaces of humanitarian care. Ebola had created an opportunity to expand research portfolios, publications and institutional prestige. In a press release from the University of Texas, for example, a research scientist at the university describes his work in terms of using survivors or other immune individuals as laborers: “If we can reliably identify who they are, they could become people who help with disease-control tasks, and that would prevent exposing others who aren’t immune.” An Emory University press release is less subtle in drawing links between extraction and scientific research in Ebola-affected communities. The author describes how university scientists have received funding to “min[e] immune systems of Ebola survivors for therapeutic gold.”

Such statements raise issues about markets, the commodification of survival and survivorship, about the production, extraction, refinement and distribution of survivor blood and labor.  Who benefits from understanding survivors as repositories to be visited, excavated and processed to derive professional, cultural and economic capital? What can be done to ensure that the benefits of these efforts can be recalibrated to care for the people who will surely be affected in future outbreaks? That survivors may be experiencing symptoms that outlast their contagiousness and immunity, conditions that exceed the “use-value” of their blood or intimate labor, has only recently been discussed, and in a very limited manner. It is here, again, that the long history of the region’s fevers, feuds [1], and trade come together in the actual blood of survivors and the markets in which they are imbricated.

[1] I owe this phrasing to Paul Farmer, who is developing a manuscript around this theme.

 

Intimacy in Africa (on film)

Intimacy in Africa (on film)

Chandani Patel writes:

When Hollywood does Africa, there’s little in the romance and love department, unless it’s about Karin Blixen making ill-fated choices (in white colonial men) or some random family who move to Africa and fall in love with the land … and the flame trees (you know the list I’m thinking about). When a white do-gooder escapee from European/British stultification falls for a gorgeous Ugandan–she’s going to get chopped up by Idi. If ever we see black characters falling in love, their romantic world is overshadowed by various external crises—warlords, corrupt politicians, locusts, famine, war (then a nice white aid worker helps one kid). Love is rarely explored in terms of the emotional and existential crises that love between two white people from America or Europe is explored, or in a silly, light-hearted way that focuses on the couple’s respective families and friends behaving badly (as in the style of, say, ‘Love Jones’ or the remake of ‘About Last Night’). [ Read more at the link ]