Investigating an Epidemic among Indigenous Children in Venezuela

In 2007, indigenous children in the rain forest of eastern Venezuela began dying from a mysterious disease. The local physician, healers, and epidemiologists could not determine the cause. When a second and third wave of deaths occurred in 2008, Conrado Moraleda, the president of the local health committee, gathered a team to carry out an investigation that state officials seemed unwilling to do. The team included Clara Mantini-Briggs, a Venezuelan public health physician, and her husband, Charles L. Briggs, a professor of anthropology at the University of California, Berkeley. They and three others visited 30 communities spread out across a large portion of the Amacuro Delta, where the Warao people distinguish their settlements from the tierra firma of the criollos (nonindigenous). Moving from town to town by motorboat, the group stumbled upon an important clue: some communities reported unusual behavior of and bites by Desmodus rotundus, the common vampire bat that can carry rabies. More evidence of this disease was presented by agonizing and telltale symptoms and a frightening mortality rate. The team halted its investigation early to notify state and national authorities. Despite extraordinary efforts, it was ultimately unsuccessful in convincing the Venezuelan government even that an epidemic had occurred, let alone one caused by rabid bats.

Una enfermedad monstruo and Tell Me Why consider why parents found no good answer to the tormenting question “Why did my children die”? The two books offer different but compatible explanations. Their differences and similarities correspond to their authors and intended audiences. The first book prints a running dialogue among the members of the team as they recount their fear and pain, their driven investigation, and their discouragement in the face of no redress. Its four authors urge social science researchers to “collaborate with other discriminated-against populations and produce interpretations of the past and the present that allow us to build futures imbued with a politics of hope and justice” (28). They present a number of interconnected if only lightly theorized reasons health authorities failed the Warao communities, including corruption and unethical behavior (48), an unsympathetic and mechanistic bureaucracy (56), the complicity of a Chavista revolution gone astray (133–134), racism (137), and a failure to recognize different health perspectives (147). Tell Me Why, written by Briggs and Mantini-Briggs, is less an open call for solidarity than an attempt to persuade an international academic audience to think differently about health, “from daily interactions with biomedical professionals and alternative practitioners to addressing some of the most pressing problems of global health.”

Central to Tell Me Why’s argument are the “health/communication inequities” that stem from and reinforce the greater health risks and poorer treatment of marginalized communities. These inequities occur when health and communication professionals produce new knowledge in multiple forms (e.g., written patient diagnoses by doctors, epidemiological reports, and health news stories) and over many sites (clinics, regional health offices, newsrooms, ministerial websites). Narratives intersect with these material forms and places in a manner that can reinforce hierarchies, stereotypes, and stigmatization rather than opening up new possibilities of corrective etiology and treatment. This is not a top-down story of projected racism on the part of high officials but an account of eddying and often lateral movement of reaffirming ideas that are hidden behind the modern scientific discoveries of doctors and epidemiologists. Discoveries seem to be carefully translated and “hypodermically injected” into the minds of lay people by sympathetic health journalists. More than 30 children die from shared and unusual symptoms, yet the details of this obvious fact are created and distorted as they are put into focus, “observed” by medical professionals, “recounted” by the health media, and interpreted locally with common sense. The title points to “indigenous knowledge,” and the Warao certainly respond, but the authors make clear that there is no correlation between ethnic identity and ontology. The delta residents “partake deeply of knowledge systems and practices associated with both biomedicine and healing” (194).

These books center on language and what it does or does not do. Una enfermedad monstruo makes language an object, placing the narrative on a stage. It reads like a play, with each chapter framing the next round of dialogic narration. It carries readers through the five stages: exposition, rising action, climax and crisis, resolution, and dénouement. Headshots of its interlocutors gaze at us in the final pages, as if the curtain had come down and the hard-working performers had come out to take a bow. It works: the stories of the victims are heartbreaking, and the efforts to find answers for families are bold. Tell Me Why, as its authors say from the beginning, “is not just an epidemiological thriller, a Sherlock Holmes-style narrative that reveals a viral killer” (5). Indeed, if language is the body to Una enfermedad monstruo, then Tell Me Why is a public autopsy. For nonanthropologists, this can be a dizzying demonstration of its parts, including the chronotopes and synecdoches of literary theory, the projection, condensation, and displacement of psychoanalysis, and the syndemics and biomediation of medical anthropology. These “organs” are connected by a (Charles Sanders) Peircian circulatory system. Pragmatism makes sense: the world is of real bodies, alive or unfairly dead, a mysterious microbial infection or environmental poison that “calls for a diagnosis” (181), and the various ways that truth is made or deformed as it moves between bedsides, clinics, hospitals, newsrooms, and ministries. Briggs and Mantini-Briggs rely on the logic of symbols (signs that refer in a lawlike way to an object), indexes (signs that are linked to objects through a relation of affect) and icons (signs that share a perceptible property with an object) to explain how some accounts were “infused with authority” while others were “cast as rumor, superstition, ignorance, or criminal behavior” (186). Through symbols, the epidemic is ultimately denied. Clearly, both books are tragedies.

Symbolic logic is used to good effect but opens the door to further analysis and a minor critique. As much as Peirce was interested in the ways people established or inherited referents through cultural convention and used them through language, his epistemology recognized a world that constantly bumped, struck, or even killed, disturbing people’s conventions and orders. This brings to mind another important Peircian triad that goes unmentioned in these books, that of “firstness” (roughly governing an abstract or “pure” quality), “secondness” (the shock or bump of experience), and “thirdness” (processes that involve mediation). The epidemic has all the qualities of secondness—out of the mundane comes a terrible shock—but thirdness matters the most in the cacophony of habits, regularities, and patterns that occur with or without human observation (Peirce, 1931). As Eduardo Kohn (2013: 59) argues, “This tendency is what makes . . . life . . . a semiotic process, which is ultimately inferential,” because regularity allows representation. “Signs are habits about habits,” and “tropical forests with their many layers of coevolved life-forms amplify this tendency.” In other words, we learn a great deal in Tell Me Why about how the habits in the world are inferred by networks of people but less about other beautifully intricate, interacting, and sometimes brutal networks of animals and things. Rabies posits an assemblage of RNA viruses (lyssavirus), glycoproteins, host receptors of brain tissue, and a range of mobile and cohabitating vectors such as the vampire bat. Other things far from the jungles carry important weight as well, such as the bodies of victims “tortured” by unannounced autopsies or Moraleda’s “dog-eared file folder . . . holding the extracted [newspaper clippings] as if they were sacred objects.” Venezuelan authorities reject bats as etiological agents, reflecting the same fear of and disgust with “unsanitary citizens” that led the state to blame cholera deaths on crabs in 1992. Why one animal is blamed and the other not is not entirely clear, since crabs and bats are both exotic critters to most Venezuelans, easily connected to disrespectful beliefs in “sylvatic” indigenous people on the fringes of their nation.

Briggs and Mantini-Briggs’s earlier book, Stories in the Time of Cholera (2004: 9) also found fault with the way an epidemic in the delta was handled, attributing the “institutional use of cultural reasoning to blame poor populations for the devastating effects of racism and economic globalization.” As a set, these three books may constitute the most detailed ongoing medical anthropological case study yet, one that covers more than two decades of investigation by indigenous and foreign experts, includes interviews of hundreds of people, incorporates a wide range of archives and primary printed material such as media and government reports, and speaks to most anthropological debates relating to representation and power, science and society, language and narrative, and race and cultural logics. The indexes of Tell Me Why My Children Died and Stories in the Time of Cholera are a “who’s who” of anthropologists and social theorists, but their ideas on how the right to health of marginalized populations may be thwarted or protected are increasingly cited elsewhere as well.

As these authors were writing, Ebola exploded, and a popular literature sprang up in the wake of the outbreak. Too often those books and articles focused on animals and things, avoiding poverty, colonization, and global inequities. The books reviewed here give a powerful corrective: ill-health emerges not just from some distant frontier between people and a wild living world but from the stories we tell ourselves and others tell about us. Nonetheless, an ecological perspective on animals and things could also help answer the questions these parents asked, in addition to why the epidemic disappeared as suddenly as it appeared. These authors give readers the compassionate and sincere testimony (combined with powerful photographs) of children like Elbia Torres, who, in agony hours before she died, was supported by Dr. Mantini-Briggs’s palliative care. “Tell me why” is a question these authors have been laboring to answer for decades. With years of experience, they have found their best success yet in addressing some of the “most pressing problems of global health” and “building a politics of hope and justice.”