Denmark’s public health system is so comprehensive, so systematic, so thoughtful, and so FREE, that it’s hard to imagine them NOT having the highest vaccination rate of children age 12 and up. According to the Borgen Project, here are some of the laudable features of Denmark’s public health system:
“All citizens in Denmark enjoy universal, equal and free healthcare services. Citizens have equal access to treatment, diagnosis and choice of hospital . . . . Healthcare services include primary and preventive care, specialist care, hospital care, mental health care, long-term care and children’s dental services.
Denmark organizes child healthcare into primary, secondary and tertiary healthcare systems. The primary level is free for all Danish citizens.
Tax revenue funds healthcare in Denmark. The state government, regions and municipalities operate the healthcare system and each sector has its own role.
The healthcare system runs more effectively than other developed countries, such as the U.S. and other European countries. For instance, experts attribute low mortality in Denmark to its healthcare success. . . . Denmark spends relatively less money on healthcare in comparison to the USA. In 2016, the U.S. spent 17.21% of its GDP on healthcare, while Denmark only spent 10.37%. By contrast, in 2015, the life expectancy at birth in Denmark was 80.8 years, yet it was 78.8 years in the U.S.
The high-quality healthcare system increases life expectancy. Danish life expectancy [even] slightly exceeds the average of the E.U.
Healthcare in Denmark sets a good example for elderly care in other countries. . . Danish senior citizens have the right to enjoy home care services for free, including practical help and personal care, if they are unable to live independently. Similarly, preventive measures and home visits can help citizens above 80 years old to plan their lives and care.“
The U.S. doesn’t have anything like any of the above systems. Instead, we value individual choice and effort over any notion of either community health or collective rights. That sounds good — until a pandemic reminds us of how lethal that value can prove.
Is it any wonder that Denmark is doing such a better job than the U.S. in vaccinating its teens against Covid?
This past month, the swans have taken up residence in our local cove, for the first time in the six summers we’ve lived here.
What could be a more beautiful way to celebrate the birth minute of my husband’s milestone birthday than a sunrise with swans?
What smiles the swans have brought to all who pass by. Plus, they’ve provided a great opportunity for conversations with admiring strangers. (“We just counted 81! How many did you count?”)
They’ve also motivated me to do some quick online research.
Turns out those oddly-shaped black blobs that sometimes rest on their backs are a leg. One leg. What’s going on with that? Does one webbed foot suddenly get tired and need a rest? Does resting a leg on a back stretch out taut muscles tired from too much paddling? Does a wet foot on some overheated feathers add a cooling touch under the hot sun? And how do they manage to navigate, anyway, without going awry from having only one limb for paddling? (Yes, I’ve seen them locomoting with a webbed foot lying on their rump.)
The anthropologist in me is frustrated no end that I can’t ask them for a direct response to these growing questions. I’ll have to keep testing out my theories using that other classic ethnographic method (which I honed while studying babies in West Africa): observing behavior and ruling out unlikely hypotheses. I wonder how likely this experiment in inter-species ethnography is to succeed.
Meanwhile, never mind their human fan club. Oblivious of us, and despite their reputation for nastiness, the swans that have taken up residence in our local harbor have co-existed happily all month with geese, ducks, egrets, seagulls, and terns.
Dare I hope the waterfowl offer a model for us bickering humans to re-gain a sense of community spirit?
We needed to find a new plumber. I called around. The first business that seemed willing to clean our boiler and replace a problematic hose spigot had availability soon. Before settling on a date, I remembered to ask the woman answering the company’s phone–let’s call her, Mary–a non-plumbing question: Will the plumber who comes into our house to work on the boiler for a few hours be fully vaccinated?
That inquiry took us to a place I hadn’t prepared to enter while finding the right vocabulary to explain our garden issue. Indeed, Mary’s unwelcome answer brought us into one of those difficult conversations we all dread these days. Here’s my best memory of how it unfolded:
Mary: I can’t guarantee that the plumber would be fully vaccinated.
Me: Are SOME of your company’s plumbers fully vaccinated?
Mary: We don’t require our staff to be vaccinated. The owner can’t force them. We’re not legally allowed to do that.
Me: Absolutely. But, the owner doesn’t have to keep paying people’s salaries if they won’t get vaccinated. That’s not forcing, that’s just his legal right to hire whoever he wants to hire. He’s got that freedom.
Mary: He won’t require it.
Me: But, are ANY of the plumbers who work for you vaccinated?
Me: Hmm. In that case, I’ll probably wait to use your services until after the pandemic is over.
I sensed that Mary was struggling to refrain from going into a political tirade about how Democrats and scientists were lying to Americans, and the vaccine would make people magnetic or sterile or digitally trackable or . . .
A normal person would have ended the conversation there. But I’m not a normal person. Suddenly, this conversation offered new possibilities for engaging with someone outside my usual social circle. The anthropologist in me was activated. I forged on.
Me: My husband and I are both vaccinated, but this aggressive Delta variant is now causing some mild, breakthrough cases that people might pass on without knowing. Since we have young grandchildren who can’t yet get the vaccine, and we’ll soon see them, we’re being extra-cautious.
Now the citizen in me was activated. Reckless, I plunged ahead.
Me: Meanwhile, since only the unvaccinated are dying from Covid now, you might want to recommend that your plumbers get vaccinated–not only to protect themselves, but also your customers.
Mary: We won’t do that.
Re-enter the anthropologist.
Me: Ah. [Pause.] Out of curiosity, I’m wondering why you don’t urge them to get the vaccine.
Mary: All our plumbers are very healthy and have great immune systems. They won’t get sick.
Me: Oh, that’s wonderful that they’re so healthy. [Pause.] Still, I keep seeing videos of people in the hospital with Covid, on ventilators, who said exactly that. This Delta variant seems to be extra-contagious and is getting so many people sick who had strong immune systems. The vaccine is a great way to protect your plumbers.
Mary: My husband and I don’t believe in the vaccine. We’re not vaccinated, and we don’t want our employees to get the vaccine, either.
Me: Really? Why’s that?
Mary: [Hangs up.]
So much for my long-honed interviewing skills. I’d have to grade myself an “F.”
But I’m never one to take failure lightly. The anthropologist in me wanted to call back and see if I could gently persuade Mary to explain her opposition to a vaccine that has so much overwhelming scientific evidence supporting its efficacy. Exactly what unfounded fears had grabbed Mary’s imagination? Who, or what, was her source of information? Why did she trust that source?
Still, the plumbing issues beckoned. Rather than re-engaging with Mary–trying to conduct instant phone ethnography that was, undoubtedly, doomed–I sighed and returned to an inventory of plumbers recommended on a neighborhood list-serv.
Phone call #2 produced an outcome at once similar, and worlds apart.
The woman answering the phone of the second business I rung up–let’s call her, Carol–offered a complicated reply that invited a conversation. Here’s what I remember of the non-plumbing portion of our exchange.
Me: Will the plumber who comes into our house to work for a few hours be fully vaccinated?
Carol: Probably, yes.
Me: Ah, that’s great. My husband and I are, too. But since we have young grandchildren who can’t be vaccinated yet, we’re being extra-cautious. Are all your plumbers fully vaccinated, then?
Carol: All but one. But, I can make sure that the one who isn’t vaccinated isn’t the one who comes to work in your house.
Me: Thank you, I appreciate that. [Pause.] Out of curiosity, is your boss encouraging that plumber to get the vaccine, to protect himself and your customers?
Carol: Actually, he’s already gotten the first shot. He just hasn’t gotten the second one yet.
Me: Oh, great.
Carol: Yeah, our boss is very big on the vaccine. He’s encouraged everyone in the company to get it. I’m the only one who hasn’t!
Me: Oh. [Pause.] Well, since you won’t be coming to work in my house, that’s not a problem for me. [Pause.] But, would you mind me asking why you haven’t gotten it, if your boss is encouraging you?
Carol: I’ve heard there are a lot of bad sideeffects. Did you have any bad side effects after your shots?
Me: Well, after my second shot, I was tired for a few hours, and the spot on my arm where I got the shot hurt a lot for about a day. But, really, it was no big deal. I’d much rather have a sore arm than die from Covid!
Carol: Oh! [Giggles, pauses a few seconds.] But,I have underlying conditions, and that’s what makes me very nervous about the vaccine.
Me: Ah, I can see that would make you nervous. Have you discussed your situation with your doctor?
Carol: No, I haven’t. I’m just reading stuff on social media.
Me: Maybe your doctor might have more information about whether your condition would make you a good candidate for the vaccine — whether it would be safe for you.
Carol: I guess so. But, I had [pauses] cancer some years ago, and I wouldn’t want the vaccine to bring that back. That was a nightmare. The treatment was so awful. And, the vaccine’s so new, no one knows what it will do, years later.
Me: I hear you. My husband was actually in treatment for cancer the past year, and his oncologist urged him to get the shot as soon as possible. He got it very early. I was online every day for a few hours, starting in January, looking for an appointment for him.
Carol: Wow, really?
Me: Yes. My husband got the first shot as soon as he could. Even though he’s now completely recovered from his cancer, now that booster shots are available, he’s going to get that third shot as soon as he’s eligible. His doctor thinks that’s a good idea.
Me: Yes, there’s a list of underlying medical conditions that make you more vulnerable to catching Covid, and suffering more, if you do. Cancer is one of them. Diabetes and asthma and obesity are some others. That’s why people with those underlying conditions were being urged to get the vaccine early on, before other people.
Carol: Hmm. You sound very knowledgeable. [Pauses.] Maybe I should consider it.
Me: Just this morning, my husband was almost in tears when he read a profile of an ER doctor in Los Angeles who is so, so frustrated with her Covid patients. None of them was vaccinated, and now, many of them are dying. As a doctor, she wants to do everything she can to help people survive, and she can’t believe that people are refusing to get vaccinated, since the vaccine pretty much guarantees that, even if you come down with Covid, it’ll probably be mild, and you won’t end up in the hospital and won’t die from it. Just about everyone in the hospital with Covid now is unvaccinated.
Carol: Where did your husband read that story?
Me: I think he said it was in the Los Angeles Times. If you like, I can ask him and maybe send you the link.
Carol: Oh, yes, please, I’d like to read that.
Me: Sure, I’ll send that to you as soon as I can.
We scheduled our plumbing appointment and Carol dictated her e-mail address so I could send her that newspaper article link. A few minutes after ending the conversation, Carol called back to double-check our street address. But first, she said, “I haven’t gotten that link yet. Are you still going to send it?”
I reassured her I would, then told her some updated statistics about Covid’s ravages that I’d read in the past few minutes. Carol eagerly resumed our conversation.
Carol: You sound so knowledgeable. I’ve enjoyed talking with you.
Me: Thank you. Same here!I do spend a lot of time every day reading updates, since the pandemic has taken such a toll.
Carol: I think I need to stop looking at social media and stop listening to people telling me not to get the vaccine.
Me: I know there’s a lot of claims out there about how the vaccine is unproven or dangerous. But, there’s definitely a lot of scientific evidence now that shows that the vaccine is super-safe and super-effective to keep you from dying from Covid. So far, something like 200 million Americans have gotten the vaccine, and no one has died from it. But we’ve had over 600,000 deaths from Covid.
Carol: Wow, really? [Pauses.] I think I’ll get it soon.
Me: That sounds like a good decision for you.
Carol: Yeah, I’m sure I’ll get it, now.
On the surface, the two women I spoke with share a lot of demographic characteristics. They’re both white. They both sounded within about 10-15 years of each other (I’d say, in their 40s to 50s). They’re both part of the working class. From a variety of speech styles and other markers, I’d guess they both stopped their formal education after high school. They’re both native English speakers. They’re both American. And they’ve both resisted getting the vaccine to protect themselves, their families, and their communities against Covid-19.
But, that’s where the similarities end. Together, Mary and Carol occupy two distinct points on the non-vaccinated spectrum in the U.S.
To put the contrast at its starkest . . .
Mary opposes the vaccine for political reasons; Carol opposes it for personal reasons.
Mary is angry about the vaccine; Carol is afraid of it.
Mary is sure in her decision; Carol is uncertain about hers.
Mary refuses to listen to counter-evidence that would challenge her decision; Carol is willing, even eager to listen to counter-evidence that might impel her to rethink her decision.
What does this tale of two women tell us about the people who have yet to get a free vaccine in the U.S. against COVID-19, despite incredible effectiveness and widespread availability? True, they’re only a sample of two. I can hardly claim that’s a scientifically representative group. But between them, these two women cover a lot of fascinating territory that I think is important, and instructive.
I draw some admittedly big lessons from my conversations with those two plumbing company receptionists. At the ethnographic level:
The “vaccine-hesitant” are not a single, homogeneous block. They include a variety of people who have arrived at their caution–or refusal–from a variety of subject positions.
If Mary and Carol offer strikingly different reasons for rejecting the Covid vaccine, they still do not represent the full range of reasons. Notably . . .
Some undocumented immigrants remain nervous about deportation, in case they have to show an ID at a vaccine clinic (as with some in the Cape Verdean community I research in Rhode Island);
Some blue-collar laborers work such long hours that they don’t find time or energy to go get a shot (as with the Stanley Steemer employee who came to clean our carpet earlier this spring, pre-Delta);
Some young people find it impossible to imagine that they could die (who among us hasn’t been there?);
Some “gig economy” workers live so precariously, from paycheck to paycheck, that they can’t risk missing a single unpaid day or two of work (why can’t the federal government address this with direct compensation?);
Some people of color retain such deep distrustof a medical system steeped in racism that they see no reason to let down their guard now (happily, physicians and nurses of color are starting to effectively address these concerns).
At the pragmatic (or, should I write, methodological?) level: Because “vaccine hesitancy” has many, diverse foundations, addressing it requires a multi-pronged approach.
“Meeting people where they are” has recently become a catch phrase among some in the medical community. That pithy motto is really just a simple way of signaling that what’s needed is an army of anthropologists. Who better to plumb people’s hidden, implicit values?
If the Biden administration were on the ball, they’d be recruiting anthropologists left and right for their medical team.
At the truly big-picture level: Education matters. Without research skills training us to evaluate the clearly false from the potentially true from the absolutely true, we are at the mercy of anything passing for “fact” that crosses our screen. Whatever the grade level, whatever the class subject, whatever the instructor’s expertise, every teacher’s first task should be to teach basic skills to evaluate evidence. The story of Mary and Carol makes it clear: our lives depend on those skills.
Meanwhile, here’s a rash prediction. This Monday, the F.D.A. is said to announce full authorization of the Pfizer vaccine. For some of the under-informed and mis-led Carols of the world ruled by a troubling combination of fear, misinformation, and eagerness for reliable advice founded in facts that regularly evade them, that authorization should provide some assurance that may motivate them to roll up their sleeves for their first shot. In short, I anticipate an enormous wave of new vaccine doses in the coming week or two, as several dams of hesitation break.
And, a wish. Maybe, just maybe, as the Marys of the world watch more people they know and even love die needlessly of Covid, at least a few of them may find some face-saving cover in the F.D.A. move and finally decide to go for a shot. After all, joining the pro-life camp of the vaccinated will confer the ultimate freedom.
The great French anthropologist, Claude Lévi-Strauss, organized his nearly-80-year-long career around a single, foundational principle: “culture” basically comes down to classification. If something is “this” (whatever “this” is), then it’s not “that.” Reciprocally, if something is “that,” then it’s not “this.”
If that observation seems banal, we rarely dwell on it precisely because it seems so obvious that it becomes invisible, like the air we breathe. Nevertheless, it’s a powerful lesson that summarizes quite a lot about the human condition. In a nutshell, our relentless urge to classify the world is one of the most important (if not first-that-comes-to-mind) features that distinguishes us from other intelligent species.
Perhaps nowhere is this species marker more sensorily evident than in an ordinary space that seems far removed from deep philosophical tenets — a garden.
True, what we choose to plant depends a great deal on soil composition and rainfall patterns. But it also reveals our values, as well as the power structures buttressing those values.
Planting a flower garden? That requires the rare privilege of having enough leisure time to value labor expended for no economically useful payoff, just sensory and aesthetic pleasure.
And, not just any flowers. A riotous garden crammed full of mixed wild flowers produces one effect.
A clearly delimited plot of begonias or rose bushes neatly lined up next to a carefully trimmed lawn produces quite another.
As for a vegetable garden — that project may result from a careful calculation to provide dinner ingredients for a small fraction of the cost of supermarket prices. Or it may derive from a busy, weekend gardener’s passion . . . or a bored retiree’s new hobby.
Likewise, the selection of exactly which seeds to sow rests on whole worlds of cultural values, conjoined with economo-political structures. Pierre Bourdieu might as well have devoted a whole chapter in his book, Distinction, to analyzing what a rare breed of Japanese eggplant versus a common variety of iceberg lettuce signals about a gardener’s educational level, financial resources, and social network expectations — all of which shape our (seemingly) personal palates.
Not only that — we like to think about gardening as a paean to life. But, to be honest, we should acknowledge the reality of the euphemism we politely term “weeding.” Gardening relies on at least as much destruction as nurturance.
All those gardens (whether filled with dinner-worthy tomatoes or vase-worthy hydrangeas) require regular “weeding” — clearing space for “this” plant to derive enough nutrients from the soil to thrive, while “that” plant sacrifices its existence for its neighbor. The decision of what to “weed” announces our values about what we consider worthy of life, and what we feel justified to kill.
All of which is to say: Today, when I decide to spend half an hour “weeding“ our backyard, every plant I choose to uproot will also make a cultural statement. Indeed, in my (culturally influenced) classificatory calculus, perfectly lovely plants meriting space in the garden take on another identity when they invade the narrow gap between cobblestones lining our driveway. That, as the anthropologist Mary Douglas would have termed it in her magnum opus, Purity and Danger, is clearly “matter out of place,” and won’t evade my trowel’s ruthless digging.
We can take the cultural foundations to gardening (suburban U.S. style) even further, seeing in it a veritable political parable. The delicate blades of Kentucky bluegrass count (for me) as worthy of life; those tall, thick stalks of “crabgrass” that threaten to crowd out their frailer neighbors merit death. In our garden, the never-ending drama of colonial domination and resistance plays itself out, one blade of grass at a time.
What can anthropology contribute to the critical conversation about race in America, following the welcome jury decision in the Derek Chauvin trial?
After they amassed and presented a week’s worth of technical details–medical, anatomical, temporal, legal–in the end, the prosecuting attorneys’ case against Derek Chauvin rested on a simple claim: A “reasonable” police officer would have removed his knee from George Floyd’s neck well before the excruciating 8 minutes and 46 seconds it took to kill him.
Miraculously, a jury of 12 peers unanimously agreed with that argument.
He didn’t put it in quite that way. In analyzing the legal system of the Barotse or Lozi people of Zambia, he wrote:
“as Barotse judges define the reasonable man, they bring into their definitions many facets of Barotse life which are not ostensibly part of the law. These facets include a variety of social and personal prejudices. I believe the same process can be detected in the decisions of our own judges and juries.”
From: Max Gluckman, “The Reasonable Man in Barotse Law,” in Order and Rebellion in Tribal Africa (New York: Free Press, 1963)
Those “prejudices”–which we might as well consider equivalent to “values”–dictate what members of particular societies consider what is, and is not, “reasonable.” Like most cultural values, these cultural models are neither universal nor unchanging.
Last week, a jury in Minneapolis gave America a gift. Suddenly, the racist justification for (white) police officers easily killing (Black) civilians is no longer a basis for a “reasonable” decision.
As Black commentators have been pointing out since the moments after the verdict was handed down in court, it will take far more than one trial to change cultural values. For, in the end, cultural values are at stake–and such values do not change quickly or easily.
Yet, thanks to the past year of BLM events remaining front and center around the country (even the globe), racism is one cultural value that no longer holds primacy in the white American imagination. Now that the eyes of the nation were trained on the Minneapolis courtroom, there is no going back to assuming that a white officer killing a Black civilian is, automatically, “reasonable.”
We must, of course, keep pushing for accountability in all police killings. Even more importantly, we must keep pressing for structural change not only to put murderous police officers on trial, but to retrain all police officers in de-escalation tactics. Re-labeling them as “peace officers” or “safety officers”–emphasizing their potential for nurturing rather than violence–might be a good, discursive start. Incorporating mental health professionals and social workers into their departments–as the city of Santa Fe did last week with their new “Alternative Response Unit”–would be a great, more tactical start.
Meanwhile, I remain proud of my discipline. The late Max Gluckman fundamentally got it right when he argued that, ultimately, legal systems rest on cultural values.
But, community standards of “reasonableness” hold sway–until they don’t. If he’d been around to hear last week’s verdict, I’d like to imagine Gluckman breathing his own sigh of anthropological relief as he nodded approvingly.
The political and military professionals ignored the warnings presaging last week’s Capitol invasion. But many who conduct research in rural Africa, while untrained in cyber-espionage, could have predicted the attack.
From living in small, rain-forest villages hosted by the Beng people of Côte d’Ivoire for nearly two years, here’s what I learned about the risks of the interregnum.
African villagers know that any transfer of power is always fraught—sociopolitically, ritually, emotionally. This liminal period–“betwixt-and-between,” as anthropologist Victor Turner described it–leaves the nation neither fully in one political space nor another. Whether they last minutes or months, liminal moments beyond life’s normal categories invite creativity, artistic license—and danger.
In Ivory Coast, Beng practices for seating a new king are a study in (ritual) risk management. Spiritual peril precedes every king’s inauguration. Before the installation, it is said that witches roam freely during the daylight hours, exploiting the temporary power vacuum. Normally, witches reportedly wreak havoc only at night; their daytime boldness is taken as especially disquieting.
Nevertheless, Beng witches are neighbors. At night, they may transform into animal familiars or other abnormal forms, but by day, they revert to their normal human appearance. One might not know that the ordinary-looking person next door, or even one’s cousin or uncle, is plotting evil using mystical means.
As the king’s ritual seating approaches—the Beng equivalent of hand-on-the-Bible-swearing—the witches’ work reaches a fever pitch, culminating in maximal damage during the moments preceding the climactic ritual. A Beng friend claimed that more people die from witchcraft during the interregnum than any other time. Babies, children, and pregnant women never attend a king’s investiture: youth of all ages are considered especially vulnerable to the witches’ power.
One might dismiss such accounts as irrelevant to a modern democracy. I suggest otherwise.
Let’s take “witchcraft” as a metaphor for any illegitimate power unleashed by evil and spiritually powerful actors aimed at harming regular humans. (That’s the Beng perception.) Defined thus, the ritual drama of Beng kingship illuminates last week’s insurrection in Washington.
The insurgents might as well have been witches. Like Beng witches, they plotted their moves secretly, online. The Internet served as the high-tech equivalent of the Beng witches’ night—complete with mysterious spaces known colloquially (with its undertone of racist imagery) as the “dark Web.”
After stealthy planning, the insurgents accomplished acts of violence ranging from physical to moral to spiritual. After all, the building they assailed was, as American schoolchildren learn, the quintessential symbol of America.
Trump even attracts acolytes espousing outlier religious traditions. One much-photographed participant in last week’s assault—a buffalo horn- and bearskin-toting QAnon follower–called himself a “QAnon shaman,” ostensibly impersonating the classic shamans of the Mongolian steppes. Such flashy devotees merely exaggerate the religious fervor Trump himself ignites; his toxic narcissism flaunts the charismatic charlatanism in which religious cult leaders often specialize.
Last week, the energy of Trump’s mob erupted so intensely that the great French sociologist, Emil Durkheim, might have termed it positively effervescent. Over a century ago, Durkheim took the explosive bubbles of a champagne bottle as an apt metaphor for the religious excitement generated by large crowds of worshippers. Durkheim had in mind large ceremonial gatherings of Aboriginal peoples of Australia convened to venerate ancestral spirits of the land. Tragically, the religious fervor we witnessed in the U.S. capital aimed at murder, not spiritual enlightenment.
Until January 6th, the genius of the American political system had managed to contain the potent energy of previous interregnums, accomplishing handovers peacefully. Following last week’s attempted coupd’état, the relevance of Beng kings’ installation rituals becomes urgently clear: moments of political transition pose the most perilous times of civic life.
Modern-day witches sport all manner of dress. Most appear commonplace, while some appropriate intimidating regalia ranging from would-be garb of the military to pseudo-shamanic adornment of Mongolia. Like their African counterparts, these American witches—unnervingly, our neighbors and relatives–simultaneously wield and mock potent symbols to perform sedition.
1. The moment that any transfer of power occurs from one individual or regime to another is fraught—ritually, sociologically, emotionally.
Why? This is a liminal period–“betwixt and between,” as the great anthropologist Victor Turner described it–neither fully in one political space, nor in another. Liminal moments offer options for creativity, inviting artistic license. They also represent spaces of danger.
Here’s what I’ve learned about the liminal times of interregnum–those intervals between political regimes–from West Africa.
For the better part of two years, I lived in small, rain-forest villages hosted by the Beng people of Côte d’Ivoire. Their practices for seating a new king are a study in (ritual) risk management.
Beng people rank a king’s inauguration as an extended moment of extreme spiritual danger. During the days and, especially, hours before the installation concludes, witches reportedly roam freely during the daylight hours, taking advantage of the temporary power vacuum. As the time approaches for the king to be ritually seated, the witches’ work increases to a fever pitch, culminating in maximal damage during the moments right before the climactic ritual. It is said that more people die during the interregnum period than at any other time. Babies and children never attend a king’s investiture: parents fear that their weakness and youthfulness would render them especially vulnerable to the power of witches. Likewise, a pregnant woman assiduously avoids the event, protecting her fragile fetus.
Some in the modern world might dismiss such accounts as anachronistic relics of an ancient era. I suggest otherwise.
At the broadest level, let’s take “witchcraft” as a metaphor for the unleashing of any illegitimate and mystical power aimed at causing harm in the lives of ordinary humans. (That’s how the Beng perceive witches.) It becomes clear how the ritual drama of Beng kingship illuminates the events of last week in the American capital. The insurgents attacking the U.S. Capitol building played the role of witches, spreading spiritual chaos.
The much-photographed costume of the fiercest-looking insurgent was worn by one Jacob Anthony Chansley–an Arizonan man who forsook his prosaic name in favor of “Jake Angeli,” with its obvious religious reference to “angel.” But his attempt to wield spiritual power was not only through reference to Christianity. In a second perverse act of cultural appropriation, the terrorist also drew on indigenous religious traditions, calling himself a “QAnon Shaman.”
That is not just a meaningless moniker. The now-notorious Arizonan claims spiritual powers equivalent to those of the classic shamans of the Mongolian steppes. Chansley has categorized himself as a “multi-dimensional or hyper dimensional being” and claims he can “see into these other higher dimensions that these entities – these pedophiles, these rapists, these really high up people … that they can almost hide in the shadows in.”
Beyond Chansley, QAnon–the amorphous collection of groups with which Chansley associates himself–itself displays many qualities of a religious cult. For one thing, its strangely spelt name hints at a secret identity: Anon[ymous]. The secrecy encoded in its very name implies mystical foundations.
Then, too, the conspiracy-oriented group promotes hyperbolic but vague claims drenched in sensationalist innuendo: Satanic kidnapping, pedophilia, child trafficking.
Moreover, according to NY Times reporter Kevin Roose, QAnon followers have also been “flooding social media with false information about Covid-19, the Black Lives Matter protests and the 2020 election.” Some have, additionally, embraced anti-vaccine and anti-child-trafficking movements; others make further “claims about the assassination of John F. Kennedy, the existence of U.F.O.s, and the 9/11 ‘truther’ movement.”
What’s more, its messages are sometimes penned in cryptic language.
All these features smack of religious cults.
Dare I point out that this shambolic collection of creative but unrealistic fears constitutes a veritable witches’ brew?
Chansley is now in custody. I’m guessing that the higher powers with which he claims to be in touch may not prove persuasive in a court of law.
But Chansley is just the side show. The main act, of course, is Donald Trump. These past four years. Trump has turned into a religious cult leader par excellence.
Trump may not drape himself flamboyantly in bearskins or sport buffalo horns, but his toxic narcissism produces just the sort of charismatic charlatanism in which certain types of religious cult leaders have long specialized. Allying himself with flashier devotees merely highlights the religious fervor he ignites on his own.
As I watch reruns of the mob scene that Trump incited, I imagine that the great French sociologist, Emil Durkheim, would have recognized the energy as effervescent, when large gatherings of people create great emotional intensity dedicated to serving ancestral spirits. Tragically, the religious fervor we witnessed in the U.S. capital produced tragedy rather than spiritual enlightenment.
Last week in Washington, D.C., the bureaucrats in charge of security failed our nation miserably. Eventually, a systematic inquiry will determine whether this failure originated in inattentive incompetence or coordinated sedition. (All signs are currently pointing toward the latter.)
For now, I humbly point out what those in charge might have learned from Beng villagers (assuming they actually wanted to protect the nation): moments of political transition represent the most dangerous times of civic life.
During periods of political interregnum, society cannot be too cautious. Leaders must take all conceivable steps to protect the vulnerable and safeguard the polity, lest the forces of chaos–modern-day witches–avail themselves of the power vacuum and take charge.
2. The institutionof democratic rule is strong, sturdy, and stable–until it’s not.
In the village, my Beng friend Yacouba once told me, “When the walls have holes, the cockroaches get in.”
Yacouba had in mind the ravages of his two co-wives. In his view, their endless bitter arguments were causing all their children to constantly fall sick; one had even died.
Yacouba’s cockroach lesson might be applied to the broader house of civil society. Once foes scratch cracks into the walls of an institution, elements of destruction expand those chips and find their way in.
In Côte d’Ivoire, the initial challenge to the modern nation’s first democratic elections occurred in 1994. The past 26 years have seen more failed coup attempts than I have counted, punctuated frequently by violent civil unrest and two periods of out-and-out civil war. Today, the nation remains as unstable as it was at the beginning of those early political challenges. Côte d’Ivoire’s recent history should serve America as a warning.
During the past week, we have heard many journalists and political experts write that America is on a precipice. But, if we want to be honest with ourselves, we must acknowledge that, from the nation’s earliest days, America began in violent efforts to either subjugate or annihilate people of color–first, native peoples; then, Africans kidnapped and brought to these shores while enslaved. To claim that we are on a precipice now implies that this is the first time we face stark choices concerning racism. In truth, we have been balancing uneasily on that precipice since the founding of the republic.
Nevertheless, each time we venture farther out on that cliff, we come closer to toppling over its edge.
The lessons of Côte d’Ivoire’s difficult modern history are still something from which it’s not too late to learn. There’s still time to conduct thorough inquiries into who organized last week’s insurrection and then prosecute them. All of them. Even if he neither resigns nor is removed from office via the 25th amendment nor is impeached, Donald Trump can, and should, ultimately be judged–ideally in court, but certainly by history.
Meanwhile, we have an interregnum to plow through.
Ed Bruner passed away yesterday, at 95–peacefully, at home. I wish my daughter and I could have been with him, but–Covid.
Ed started out as my senior colleague in the anthropology department at the University of Illinois. He soon became a mentor, then writing/editing buddy, then dear friend, then adoptive grandfather of my daughter. With 37 years of a richly multi-layered relationship, how do I begin to mourn?
I will post some memories soon. For now, I just wanted to inform my anthropology colleagues that our discipline has lost a great scholar.
Meanwhile, if you’re not familiar with Ed’s wonderful writings, a few of his many brilliant articles are available for download on his ResearchGate page here–catch them while you can.
August 8, 2020
Some especially strong memories of Ed Bruner will always remain. Here’s one.
In my early years as a professor, he and Ann Anagnost and I co-created a graduate course (on Symbolic and Interpretive Anthropology) and co-taught it twice. I learned so much about how to teach from that semester, watching Ed masterfully lead discussions like an orchestra conductor. He always knew when to lecture, when to call on the quiet student, when to apologize for having been unclear or unfair, and how to lighten the moment when two students risked having their theoretical disagreement turn nasty. In that classroom, Ed taught me to be an anthropologist of our students, to pay attention to their realities and meet them where they were. He also modeled the righteousness of democracy.
Although Ann and I were un-tenured assistant professors, and Ed was already a full professor and had been head of the department many years earlier, he treated the two of us as fully his equals. We co-created the syllabus, each of us meticulously responsible for one-third of the readings and leading one-third of the class sessions; we divided up all other responsibilities equally, even the grading–Ed never shirked on his share of work. In that classroom, Ed modeled egalitarian values that I still try to live out.
There’s also this: When Ann and I both became visibly pregnant toward the end of our second round of co-teaching, Ed never made us feel out of place, as many male colleagues might have, for our bulging bellies. In fact, he joked about his disadvantaged position as the only non-pregnant instructor. Although he came of age well before the second wave of feminism changed America, Ed’s basic humanity led him to feminist stances, even if he didn’t know to call them such. So, when I started schooling him in the basic tenets of feminism, he was a quick study. I was just giving him a vocabulary for something he already knew–that women are human.
In my next post, I’ll address that hunger to learn.
August 9, 2020
August 9, 2020
Soon after I arrived as a new professor at the University of Illinois, a graduate student in my department offered me his version of a rundown on all my new colleagues, complete with some juicy nicknames he’d concocted. His moniker for Ed Bruner: “What’s-New Ed?” This grad student gently mocked Ed for having switched intellectual paradigms more than once. I was intrigued and resolved to understand what lay behind such multiple shifts.
What I discovered was a voracious appetite for knowledge. Ed frequently asked me what I was reading and told me excitedly about what he’d just read. For years, he was a member of an interdisciplinary reading group that exposed him to new trends in the humanities. In mid-career, reading interpretive theory led him to migrate away from the positivist orientation of his graduate school training and help forge what became known as interpretive anthropology. Ed edited two influential collections of essays (one, with Victor Turner, one of my own mentors in grad school) that marked the interpretive turn in anthropology. To further cement this major shift and legitimize humanistic perspectives in anthropology, Ed helped found the Society for Humanistic Anthropology, and (ever generous) he (anonymously) funded its Victor Turner Prize in Ethnographic Writing.
For all his humanism, Ed also loved science. His first major in college was engineering; his son became an engineer; and he never relinquished his fascination with the latest STEM discoveries. Into his 90s, Ed was always the first person I knew to buy (and master!) the latest cell phone model; I learned about GPS technologies installed in cars from Ed, who once proudly gave me a detailed tour of his new car that had one of the first GPS technologies available. Once my son started working as a software engineer for Apple, Ed enjoyed geeking out with Nathaniel about the most minute of tech niceties. When the field of anthropology was being torn apart by bitter and rivalrous claims between the humanistic and scientific ends of the discipline, Ed wrote a piece for the major anthropology newsletter gently taking us all to task for seeing the two perspectives as mutually exclusive. When that disciplinary rupture started tearing apart our own department, Ed’s was always the calm voice of reason at faculty meetings at which reason was in short supply.
Ed’s intellectual adventurousness didn’t only lay in theory–he also lived it. He conducted his earliest research with Native Americans, then switched to study Indonesia (and learned the Indonesian language). Late in life, he started a major new fieldwork project of studying tourist behaviors around the world. Observing American tourists in Asia, Africa, and the U.S., Ed helped forge Tourism Studies as a serious discipline.
Ed’s book, Cultures on Tour, a compilation of his best articles on the topic, is must-reading on every Tourism course syllabus.
Back in 2014, a session at the annual meeting of the American Anthropological Association addressed Ed’s impactful work on tourism. That session was so strong that the participants decided to publish their talks. Such projects always take more years than anyone predicts. As Ed’s health declined, awaiting the publication of that book became one of the things that kept him going.
When The Ethnography of Tourism: Edward Bruner and Beyond appeared last October, Ed felt gratified that much of his life’s work had firmly found its place in the scholarly world.
For my part, Ed’s scholarly globe-trotting gave me courage to contemplate my own major fieldwork switch (from Côte d’Ivoire to Cabo Verde). I was thrilled when Ed agreed to write what turned into a magisterial chapter for a book I edited (The Restless Anthropologist), thoughtfully and honestly looking back on his (then) 60 years of global field research.
Ed didn’t only read scholarly work; he also devoured fiction. Once, my writer-husband, Philip Graham, mentioned a list-in-progress he kept of his favorite works of contemporary world fiction, to share with his students. Ed begged for the list and soon started reporting his impressions of the books he was reading. After plowing through the initial list of hundreds of novels and short story collections, he kept requesting Philip’s periodic updates.
In short, Ed was a model for his students, and for me, of how to be a scholar–not the kind of scholar who revels in the trivial, or who defends a single idea to the grave, but the kind of scholar who remains perpetually intellectually alive and open to the world of ideas.
When she was three years old, our daughter Hannah declared that she needed us to find her a grandfather. Both of her biological grandfathers had died before she was born, and she felt that lack early. I asked her if she had anyone in mind. She asked me to list all the older men in our lives who she knew. When I got to Ed’s name, she stopped and said, “That’s my grandpa.”
At that point, our daughter had only met Ed a few times. Until they were old enough to balk, my husband and I regularly dragged our children to conferences, dinner parties, lectures, classes, and even some faculty meetings (poor things), to keep them an active part of our lives. That meant, they got to know a lot of adults. At the cocktail parties that Ed and his wife Elaine (“Cookie”) hosted, Hannah was usually the only child present. Ed had always taken kind notice of Hannah: asked her what she’d like to eat, found her a cozy spot to sit, asked if she was afraid of his large dog (she was, and Ed removed the animal to another room). Clearly, Hannah (always emotionally wise beyond her years) intuited that Ed was someone who was sensitive to other people’s realities, even those of a far different age category. Hannah picked well.
Over the next 23 years, Ed indeed became our daughter’s grandfather. (He already had grandchildren from his son, but they lived a couple of states away.) Year after year, Ed and Cookie bought our growing daughter the perfect, age-appropriate presents for her birthday and for Chanukah. When she was young, there was a stuffed panda bear about three times Hannah’s size, which occupied a very large corner of her bed for many years.
In middle school and high school, there was an increasingly sophisticated set of jewelry gifts. In college, there was a designer purse. When Ed was heartbroken that he couldn’t travel to Rhode Island to attend Hannah’s college graduation in 2017, he sent the largest flower bouquet he could.
Nor did Ed’s involvement end at charming and extravagant gifts. In elementary school, Ed-as-Grandpa came to Hannah’s school performances; in high school, he watched her cheerleading gymnastics. When the first serious boyfriend entered Hannah’s life, Ed insisted on meeting him and giving him The Grandfather Talk (complete with You’d-Better-Treat-My-Darling-Granddaughter-Right sort of warnings). When Hannah had an offer of an internship at a very prestigious art gallery in NYC the summer after her junior year in college, Ed helped subsidize her overpriced NYC studio sublet (which happened to be close to the old site of Stuyvesant High School, the competitive high school that Ed had attended decades earlier). When it came time (a few years back) to donate his professional papers to the Wenner-Gren Foundation and figure out what to do with his extensive library, Ed had Hannah sort through his books and papers and organize and pack them up.
Last week, Ed learned from his doctors that the end of his days on this earth was approaching, and he wrote me a farewell note. After tearing up, I shared the terrible news with Hannah. Immediately, she called Ed on FaceTime and they had their final conversation. By now, Hannah had a new partner. She’d hoped to introduce Andrew to Ed on a trip back to Champaign-Urbana (for a dear friend’s wedding) this past May, but, to everyone’s deep dismay, Covid postponed that trip (and wedding) until next May. Hannah fretted greatly about the delay in seeing her rapidly aging grandfather; last week, her worst fears were confirmed.
It meant the world to her that she was able to introduce Andrew to Ed over FaceTime. I don’t know what Ed said in that final conversation, but it must have been just the right thing. Ever an anthropologist, Ed must have managed to intuit Hannah’s mood and speak to it because, although Hannah emerged crying, she also emerged in peace.
Thank you, Ed, for that final gift to your beloved, adopted granddaughter–and for living out your scholar’s understanding of the bonds of kinship. Anthropologists have long known that what we used to call “fictive kinship” can feel as real, as deep, and as meaningful as any bonds forged by biology. Ed demonstrated that theoretical insight as lovingly as anyone might.
August 12, 2020
Last installment of my thoughts about Edward M Bruner (at least for now).
Ed and I were 30 years apart. When we met, he was twice my age. That age difference might appear to offer an unpromising basis for a friendship. In choosing friends, most of us tend to find a path to people who are like us in some obvious ways. Age and gender often rank high on the list of shared criteria. For Ed and me, somehow, neither of those differences interfered with our friendship.
My inspiration was my long-ago Beng friend, Amenan Véronique. One late afternoon, while we were chatting in her compound in the rain forest of Côte d’Ivoire, Amenan excused herself from a conversation, to take dinner over to someone across the village. When I asked about the recipient, Amenan said she was bringing the dish to a very elderly woman who couldn’t easily cook for herself any more. I asked if she was an aunt–in those villages, most people are related to each other in some way or another. Amenan surprised me by telling me that they weren’t related at all–they were friends. At the time, Amenan was in her early 30s, and the age gap further surprised me. “Age doesn’t matter for friendship,” Amenan quietly declared. Ed re-taught me that lesson.
Over the years, Ed and I indeed became friends, of the sort that, in most places, women typically reserve for each other. Ed told me about changing dietary decisions and showed off a new suit or cashmere sweater he’d bought himself. We regularly confided in each other about family issues. As he aged, he asked my opinion about whether he should get this or that medical treatment for this or that condition. That sort of vulnerability that is the hallmark of a good friendship is harder to establish across age and gender divides; to Ed, it came easily.
None of those intimacies prevented Ed from critiquing my work when he thought I needed to rethink a point in a manuscript-in-progress. But it did mean that his critiques were delivered especially kindly, and that I took them especially seriously.
Four years ago, telling Ed that Philip and I would be retiring and moving to Rhode Island was the hardest Goodbye I had to say when we left east-central Illinois after 33 years. Ed was already 91, and increasingly feeble. Nevertheless, he managed to give a beautiful speech at the retirement party my department hosted.
We left unspoken our worries that we might not see each other again. I am grateful that I did see Ed during a trip back to Champaign-Urbana a year later.
Recently, I checked in with Dr. Bjørn Westgard, to see how he was doing.
Back in the ‘90s, Bjørn was enrolled in a wildly demanding, combined M.D./Ph.D. program at the University of Illinois, where I had the pleasure of serving as his academic advisor. After completing his medical school coursework, Bjørn conducted doctoral research in cultural anthropology in a small town in northern Senegal, studying the complexities of intersecting local and global medical systems as they sometimes complemented one another and sometimes competed. He intentionally combined “bottom-up” and “top-down” perspectives, interviewing everyone from village-based farmers and healers to biomedically trained nurses and doctors. (From that research, Bjorn is fluent in French and Wolof, the most widely spoken language in Senegal; he also speaks Serer and Mandinka, two linguistically unrelated languages spoken in the region of his research.)
When it came time to choosing a medical specialty in which to pursue his residency, Bjørn surprised me: he decided against his early interest in pediatrics or family medicine and opted instead for emergency medicine.
Initially, I was disappointed: I thought that working in ER rooms would waste Bjørn’s formidable scholarly skills. How could he get to know transient patients and put his extensive training in biomedical cultural sensitivity to work? Of course, Bjørn had already thought through that concern. “There are more return patients than you’d think,” he explained. Bjørn understood what few others in the U.S. yet knew: that many, many uninsured Americans used emergency rooms for routine medical services. That included the poor and the undocumented—for all of whom, Bjørn (with his ample wading into the deep waters of culturally sensitive issues) would have special insights.
Bjørn had an additional reason for selecting emergency medicine that made equally compelling sense. “There’s so much wrong with the American medical system, and a lot of it is encapsulated in ERs,” I remember him explaining. “As an anthropologist, I can start addressing the systemic problems if I have a position working in the belly of the beast.” At the time, no one was talking about this problem in such clear ways–at least, not in public conversations about healthcare policy. I remember being instantly both impressed and persuaded: Bjørn was making the right decision.
Besides, if I thought about everyone I had ever known, Bjørn would have been my first pick for an ER doctor. He has the sort of calm temperament and clear, logical mind that would make him the obvious choice for captaining any sinking ship.
Fast-forward fifteen years, and Bjørn now finds himself working as Research Director and Senior Staff Physician at Regions Hospital, aLevel 1 Trauma Center in Minneapolis thatsees over 90,000 Emergency Center visits every year. A Fellow of the American College of Emergency Physicians, Bjørn holds secondary medical appointments in emergency departments of four other hospitals in Minnesota and Wisconsin.
Clearly, Bjørn has harnessed the wisdom he gained from studying pluralistic health practices in a small town in Senegal to the technical skills he gained in studying medicine. With his incredible combination of scientific and humanistic talents, I was unsurprised to learn that Bjørn is now leading a medical team that is fashioning policy responses to COVID-19 for the state of Minneapolis.
On his home page, Bjørn describes his approach to medicine this way:
My teaching and research have focused on Emergency Department use for preventable conditions among priority populations, “food deserts” and diet-related Emergency Department visits, longitudinal changes in Emergency Department use among the homeless, supportive housing, and reducing health disparities in emergency care.
Who could be more qualified than an ER physician-anthropologist such as Bjørn Westgard to understand the COVID-19 crisis in both scientific and human terms?
(You can read a brief bio of Bjørn Westgardhere and his LinkedIn pagehere.)
Recently I had a conversation with Dr. Bjorn Westgard about this long COVID-19 moment—about what he has learned, and what he can teach the rest of us.
BW = Bjorn Westgard
AG = Alma Gottlieb
AG: An ER doctor in New York, Dr. Cameron Kyle-Sidell, recently claimed that ER doctors around the world may have drastically misjudged the nature of the COVID-19 beast when it enters the lungs, and may have unintentionally harmed patients by keeping them attached to respirators administering too much pressure on fragile lungs. His claims are quite striking and disturbing! If this ER doctor is right, it’s tragic to think of what damage might have already been done by mis-calibrating those respirators. What do you think of his claims, medically? And, why do you suppose he posted this video on YouTube for general consumption?
BW: This has gotten a lot of play. Unfortunately, his understanding of high-altitude pulmonary edema is a little off, and no one has put anything together about his critique that is systematic or peer-reviewed. However, multiple physicians from China, Italy, and New York in particular (on some emergency medicine podcasts and the like) have raised the possibility that treating COVID using ventilator parameters for ARDS [acute respiratory distress syndrome] may be incorrect, at least initially.
The ventilator management of these patients doesn’t sound incompatible with early ARDS, but it is still very controversial. I just got into a heated argument with an intensivist earlier today for even bringing up the above. There is fear among all sorts of health professionals right now, especially among those who tend to “know what they know” with the most certainty. So the idea of managing critical pathophysiology that might be different from what is expected–requiring a veritable,Kuhnian paradigm shift–can be very anxiety- and anger-provoking.
To add further fuel to that fire, there has also been discussion of a possible hemoglobin issue (oxygen carrier in the blood), but there has been nothing other than a pre-press 3D computer modeling paper out of China in the rapid-fire literature to support that idea. However, a group from NYU did use machine learning to predict severe disease, with results that could support the idea of ahemoglobinopathy. I even have colleagues in my other Board specialty, hyperbaric medicine, who are working on a trial to use hyperbaric oxygen to get around the possible hemoglobin issue. I think there’s probably more to the receptor for COVID, which is present in all of the body’s vasculature, which could potentially trigger inflammation and coagulation that way, and that inflammation and small clots, which we’re finding everywhere in coronavirus patients, could be causing diffuse injury.
It’s fascinating to watch the accretions of science and knowledge in the age of the Internet and social media. Already, cranks are hawking conspiracy theories and supplements in response to the “censored” knowledge above.
As an emergency physician and an anthropologist, I’m a bricoleur of the contingent and the emergent, by trade. I’ll consider new ideas if they make pathophysiologic sense, and I have no doubt that someone will examine these ideas further and more systematically, so I’ll keep watching for more evidence. For now, I’ll care for the patient in front of me and adjust their vent settings as needed.
AG: That sounds like a good strategy both for an ethnographer and a doctor. But then, I always thought that all doctors ought to have training in anthropology.
BW: I hope I didn’t give you the impression in my last email that I was resistant to the ideas presented, just that I’m looking for more information, whether from personal, clinical experience or other data. I’m just not generally inclined to change my clinical practice in response to social media. I’m in the middle of our Thursday morning residency conference right now, and we’re discussing initial and ICU ventilator settings, given developing information, and it’s fascinating to hear an intensivist colleague suggest that “we’re all in the same boat here, the attendings [fully credentialed, attending physicians], the fellows, the residents, and the med student . . . we’re all learning together as we go.”
AG: Speaking of combining social and technical approaches, we’ve been reading about efforts to systematically calculate social contacts for COVID-19 patients, to help track the socio-geographic spread of the disease. What do you think of those?
BW: Very cool. I’m trying to get our state to do something similar using an app I’ve worked with a team to develop. I’m arguing with our Department of Health, who have difficulty appreciating how technology might help. But they’re also feeling less pressure to consider novel options, since our state is doing relatively well.
AG: Here’s something else I thought you might have a lot to say about . . . the whole “herd immunity” question strikes me as so interesting for anthropologists. I’ve been reading a lot about this recently. This piece in the Boston Globe really caught my attention.
First, there are the epidemiological questions. How accurate is the concept of “herd immunity” to begin with? As a doctor and scientist, I assume you’ll have much to say about that.
Second, there are the sociological implications. How can your perspective as an anthropologist speak to the epidemiological factors? If the US (and/or other nations) adopts a “herd immunity” approach at some point (before a vaccine is widely available), what sorts of people will be allowed—or even encouraged–to be exposed to the virus? What sorts of people should be allowed, or even encouraged, to be exposed to the virus? Are those two groups of people the same? Or, will socioeconomic disparities intervene, and might large numbers of the wrong people (the most vulnerable) end up being exposed to the virus? I’m thinking about this because, over the past two weeks, many mainstream journalists in the U.S. have begun noting racial disparities in COVID-19 mortality. Of course, that’s no surprise to anthropologists (and some other social scientists), though it seems to be surprising plenty of politicians. Thinking about these social factors, are there new risks to perpetuating racial disparities with a “herd immunity” strategy?
Third, there are the symbolic/conceptual/philosophical implications. As a scholar steeped in sensitivity to discursive implications, what are the ramifications of using a metaphor of (non-human) animal behavior for human behavior, in evoking “herd” immunity?
The maddening “organism at the edge of life” (as virologist E. P. Rybicki describes viruses) that is far too dangerous to appear this beautiful
BW: I haven’t had time until after my shift this evening to get to your questions, but I like them. It prompts me to reflect and consider with a wider lens.
I’m not an expert in infectious disease or epidemiology, but my understanding is that “herd immunity” is primarily a statistically useful concept that expresses the aggregate balance between immune systems and infectious vectors such that there’s enough immunity to prevent ongoing transmission. But when you get into the immune system, things become very complex very quickly. Talking about vaccines and immune medications (like those being discussed as treatments forcytokine storm, for example), the questions pertain not just to the dose of a drug in the volume of an aqueous human, but also to what the most productive triggers are for the bodily machinery churning out the immunity widgets of antibodies. The questions become: What is needed to trigger the production of immunity? How effective is the immunity that is produced? Does it wane, and if so, when?
And all that is without discussing the social patterns of intermixing that we all experience, and which have become the main means by which we are currently intervening upon the spread of this pandemic. I think that’s where the concept of “herd” becomes interesting. Anthropologists and many others are comfortable with the idea of the population as a biopolitical concept generated by a certain kind of governmentality. But how do we, the multitude, deploy that in an effective, self-governing manner?
It seems to me that the concept of the “herd” could allow us to conceive of our collective biology, our animality, in a way that is positive and potentially collectively empowering, rather than biostatistically disempowering. That said, it seems clear that a “herd immunity” strategy that treats the lot of us like chattel (the flip side of the “herd”), positing that we should all “put on our big boy and big girls pants” and accept that a lot of people must die, will undoubtedly do more harm. We’re seeing this in those areas of the country where few or late actions have been taken to mitigate the spread of coronavirus.
It’s my hope that we’ll use available information from around the world to develop better methods that capitalize upon our current collective engagement. It seems like “flatten the curve” has brought the collective back to the biostatistical. Hopefully, well-thought-out approaches to “reopening” and easing social/policy measures could do the same. But the evidence for these measures is thin, and we are all learning about one of my favorite areas or research, complex population models of disease. This is another area where science is being built daily, as the pandemic provides some of the first empirical test cases for these tools.
But it is disheartening that in areas both with and without aggressive measures, we see the impact of racial and socioeconomic disparities. Those disparities are at play in health inequities and inequitable care in the best of times. Now, resources are strained, so it would be almost unthinkable that those factors would not be significantly at play in the pandemic. In areas with less, or late, social and political measures to isolate people, the historic clustering of populations through systemic segregation, with associated increases in population density and decreases in access to resources, lead tosyndemic conditions. In areas with more social and political measures to isolate people, many who work low-end jobs become unemployed, with all the accompanying fears and hardships, while those who keep their low-end jobs–clerks, janitors, service workers, etc.–are left out in public in positions that put them in contact with large numbers of potentially infectious people. So, between the two groups, disparities in rates of infection and adverse outcomes should come as no surprise.
I’ll get back to you with more, as this is the next bit of thinking required. In Minneapolis, the group I’ve assembled between HealthPartners and the University of Minnesota are going to consider how to model this process to provide guidance for the long term of the pandemic.
AG: Yes, racial disparities are emerging with disturbing alacrity and intensity in the US. But, as you say, that’s hardly a surprise, for all the reasons concerning systematic, structural disempowerment that have characterized US society since Europeans set foot on these shores. Those sorts of disparities have begun to be part of a growing national conversation since the Civil Rights movement of the ’60s, and they took on new force more recently with the Black Lives Matter movement. One of the components of the current horrible moment that I’m actually finding most heartening is the extent to which social conditions ARE finding their way to being front and center of many conversations. It strikes me that this moment of national (and global) crisis offers America new opportunities to expand that conversation and really take its lessons seriously in a new way for the first time in US history. And, medical researchers and doctors will be at the forefront of that conversation. Someone like you, with your dual training, is especially well positioned to think systematically about just how to operationalize those lessons in ways that work with public health protocols. That’s why I’m excited about our continuing conversation!
BW: I think it’s very clear that this virus is hitting communities in both indiscriminate ways (with some reportedly healthy individuals going on ventilators or even ECMO life-support machines) and in VERY discriminating ways, hitting poorer communities and those of color. What I haven’t heard exactly is any discussion about ways to focus resources on those communities that are hardest hit, which is disappointing but not unexpected, given the current national leadership.
I actually think race and structural inequalities and violence have very much come to the fore within medical practice. It’s just that our sphere of influence is limited. For example, in Minnesota, our healthcare system has an Equitable Care Committee that has done a lot of great work, although it has vacillated between focusing on equitable care and health equity, depending upon what we think we can actually achieve. Residents and med students, particularly the med students, are very aware of disempowerment, and it’s one of the things I teach about when I’m on shift [teaching residents]. In fact, next week, I’ll be drawing directly from anthropology in giving a talk as part of a panel at our Society for Academic Emergency Medicine national meetings (now online!) about teaching residents to be “structurally competent”—meaning, thinking about larger, structural issues that shape the experiences they see in particular patients.
What’s most difficult is to figure out how to get beyond the clinical domain and affect pathologies upstream, closer to their source. It helps one understand why Paul Farmer long ago advocated for large-scale wealth transfers between north and south, and why we need to do the same in the U.S. That’s actually some of what was achieved by the Affordable Care Act but then was largely undone or undercut by recent tax cuts for the wealthy. So it’s good that these issues are front and center, but I think they could be even more so. And it’s good that we’re thinking communally, as I said before, but the idea that we might differentially focus collective resources upon communities that are hardest hit seems to meet resistance with predictable frequency.
AG: In Rhode Island, where I now live, there’s actually a vigorous initiative (Beat COVID-19) with just that emphasis. Beyond the capital, the two cities hardest hit in Rhode Island are Central Falls and Pawtucket, both of which have large, immigrant communities of color (mostly from Latin America and Cape Verde). The current rate of infection in both those cities currently surpassess that of New York City. Nationally, these two small cities are invisible in news reports, but locally, a multidisciplinary coalition has formed that is forging creative approaches to reach these communities. The coalition includes a normally unlikely set of folks, including a local doctor, representatives from the state’s Department of Health and the two cities’ police departments, marketing specialists, local community organizers and advocates, translators, and even yours truly, as an academic critic. I’ve been heartened to see a far more open-minded approach to reaching these communities than I would have imagined. For example, since many residents of these neighborhoods feel more comfortable speaking either Spanish, Portuguese, or Care Verdean Kriolu, a new COVID-19 hotline in these three languages now welcomes callers, and there are now public service announcements in those three languages that are being promoted online in all sorts of social media spaces where people from these communities are likely to read them. I’m so impressed by what I’m seeing that I’m starting to consider this local initiative a model for communities elsewhere.
Once COVID-19 starts hitting the white heartland–as now seems inevitable–because of resistance both by Republican governors and local residents to maintain social isolation procedures, and insistence to “re-open” the economy prematurely and indiscriminately–it will be interesting to see how those communities respond to the crisis suddenly invading their families. As a physician, I imagine you must feel quite frustrated by those conditions.
BW: Just look at the largely white nationalist forces that have hijacked what began as small-business protests about state efforts to enact social-distancing policies, in an effort to minimize the impact of the COVID surge.
Those folks are having trouble getting on board with just the baseline collective actions needed for public health. Currently, so many folks in the rural parts of the country see this crisis as an urban thing. But if we look back at the influenza pandemic of (supposedly) 1918-19–which actually lasted three years (my grandfather nearly died of it in 1921)–the initial wave hit densely populated areas, but the next waves were largely rural. And today, if you look at rural areas, they’re as disproportionately disadvantaged as are many of the low-income, urban communities from which we’ve divested as a society. In fact, rural America overall is actually less insured, has less access to services, and is more dependent upon government transfers of resources than is most of urban America. So, I’d really like us to be able to see both of those kinds of communities with one gaze.
AG: That makes a lot of sense both politically and intellectually. It will be interesting to see if white conservatives come around to that position, once they are affected.
Since you’re enjoying thinking about epistemological issues raised by COVID, I wonder what you might think of an e-mail I recently received.
A prominent medical school has decided to confer MD degrees a little early, for med students who had completed all their training and were scheduled to receive their degrees within a few months. (The e-mail subject line read: “Emergency Powers Exercised: Approved Early Degree Conferral of 4th Year Medical School Students.”)
That will allow these brand-new medical residents to start practicing in COVID-19 hotspots and help alleviate the hospital crisis in those areas. Seems like a great idea–this is a good time to challenge bureaucracy, right?
But I also saw an online petition on a related question that made me more nervous–to grant “registered nurse” (RN) licenses to “licensed practical nurses” (LPNs), who have quite a bit less training than registered nurses do. That struck me as way riskier. But perhaps I’m being too conservative. Maybe LPNs are actually being asked to do the work of RNs in this crisis, and so they should be credentialed and salaried accordingly. What do you think?
BW: I definitely agree with deploying fourth-year medical students early. It strikes me as a safe move at this time in their training.
However, in areas that are not already seeing surge conditions, I think the country would be best served by deploying medical students to docase-contact tracing.
And I agree with you that granting RN licenses to LPNs is riskier. Credentials are indicators of different kinds of training, and their significance should be maintained, though that’s the professional in me coming out and maintaining boundaries.
As with many things at the moment, one could simply and temporarily alter practice parameters for surge or crisis standards of care.
AG: I recently read another, especially thoughtful piece in the New York Times, about when to “re-open America”—with the intentionally provocative title, “Restarting America Means People Will Die. So When Do We Do It?” A staff writer for The New York Times Magazine moderated a panel discussion with five people with varying backgrounds (a minister, an economist, a global health specialist, a civil rights specialist, and a bioethicist). They raised sociological issues related to those raised in the Boston Globe piece about “herd immunity”–but from broader perspectives, and more critically, I think. Lots of food for anthropological thought here. As a physician-anthropologist, you can, I imagine, bring special perspectives to this emerging national conversation about how we think about risk in “re-opening society.”
BW: There definitely needs to be attention to those who are at higher risk for contracting and dying from COVID-19, and to those communities whose residents don’t have a choice about going back to work. It’s really a matter of whether people are forced to be at risk, or are allowed to be agents of their own risk and that of their loved ones. Are we going to make re-opening businesses opt-in?
Unfortunately, the baseline state of affairs in America is far from a level playing field. Some people will, essentially, be forced to work so that states don’t have to pay them unemployment benefits, and small business owners will be forced to run risk so they can qualify to get loans and other state-funded stimulus funds. Yet, somehow, there’s no national conversation questioning whether oil, airlines, and other large industries should be bailed out.
I think we could consider restarting by focusing on the social and the scientific. I think most of us would be doing better with all of this isolation, quarantine, and lockdown if we had a few more people to connect to. If you look at places that are opening up, or even how we started this all, we could start clustering in smaller groups, 10 people or fewer. Just folks who you would know were sick. And we could get the kids back together. Given the low likelihood of adverse effects in children, the fact that they have been much less symptomatic, but that they are also very good at transmitting disease to each other (just ask any parent of a daycare child), getting them back together would get us started with herd immunity. Bioethicist and oncologist, Zeke (Ezekiel) Emanuel was one of the first to say that we should probably get summer camps up and running. To me, that makes sense. But, again, it’d have to be opt-in, both for those who run the place and those who go to camp.
AG: Scholars and doctors aren’t the only ones talking about how to protect ourselves from this virus. I just discovered a pretty awesome rap video about COVID-19 from Y’en a Marre, a group from Senegal (here). Any thoughts?
BW: Y’en a Marre are a great group. They were instrumental inmobilizing the youth vote to get Wade out of power in Senegal, so I feel like they’re always “au service du peuple et de la nation” [in the service of the people and the nation]. It’s so interesting how hip-hop and other forms of art in a smaller country, fending for its own identity and economy with a smaller media space due to the constraints of language, can be called on–if not officially (like this probably was), then culturally–to serve the body of the nation. In this new video of theirs, I love how they’re all doing scientific activities–looking at charts, microscopes, and blood specimens–instead of just striking stereotypical poses in hazmat suits. It’s a solid video. I can’t imagine many hip-hip artists in the States pulling something similar off with the same tone–in Minnesota, maybeAtmosphere, but not many others in the national mediasphere.
AG: You mentioned that you’ve just co-authored a short piece about COVID-19 that you’ve submitted to a medical journal. Can you talk a bit about the orientation of that article? Were you able to insert an anthropological perspective into an article for a medical journal?
BW: In Minnesota, we’ve just had a huge decline in visits to the emergency department and to the hospital for just about everything. Most of the news outlets have covered it, but no one has published any numbers or more detailed reports of what’s not coming in. I’m fine with a slowish day in the ER, but across the country, particularly in those places not seeing the surge, the changes in patient volume have had devastating effects on clinics, hospitals, and health systems that have to operate at near full capacity and with razor thin margins in normal times just to stay afloat. So, at the same time as we have surge, we’re also seeing mass furloughing and pay cuts for nurses, doctors, and even (gasp) administrators.
So we just pulled the numbers for before and after our great Governor Walz’s announcement of a statewide “peacetime emergency,” comparing volumes and visits to a year ago, and we found a 70% drop off in strokes, and a 50% drop off in heart attacks, but also declines in really painful things like kidney stones, too. And, who’s not coming in? Well, it’s the elderly, children, and those who have insurance through Medicare. Much of this drop is likely prudence on the part of high-risk individuals, but we know there’s also some desire to not burden the health systems with non-COVID related care, as well as some fear of actually contracting coronavirus in healthcare settings.
Similar trends have been seen in China, Taiwan, South Korea, and Europe, as well as in chronic care. In Minnesota, the HealthPartners Institute has a chronic care surveillance group, and they saw visits drop off by 90% in three days after the statewide announcement.
We’re interested in doing follow-up studies, monitoring for the effects of delayed or deferred care, both acute and chronic, and seeing who comes back first, and with what.
AG: That sounds like an important set of considerations I haven’t yet seen anyone talking about in the press. Everyone is so focused on the now of the emergency, and how to extricate ourselves from it, that few I’ve seen are allowing themselves the luxury of imagining ancillary questions such as those you’ve just raised. Again, I imagine your training in anthropology makes it easier for you to keep your eyes focused not only on the big picture, but on seemingly unrelated factors that, in the end, turn out to be deeply related. That’s what we do in anthropology, right?
Well, let’s end on a positive and practical note. Last week, the team you’re leading produced a new app, “SafeDistance,” to provide up-to-date information about COVID-19 incidence in micro-neighborhoods.
Online, the website for the new app describes it this way:
SafeDistance is a free, non-profit app and website that crowdsources symptom data to help detect, predict, and prevent the spread of COVID-19, while assuring your privacy.
· Personalized, social distancing recommendations
· Neighborhood-level COVID-19 risk map
· Privacy assured – no account required, you remain anonymous
Can you talk about what sorts of social knowledge about Minnesotans factored into how you designed the app for ordinary people?
BW: The basics are maintaining privacy while collecting data of actionable utility. So we’re focusing on anonymity–both to allay privacy concerns, and also to make it an easy tool to begin using. Instead of identifying individuals, we’re mapping and doing analytics by neighborhood. This approach allows both individual users, and anyone else who is interested in the data from a more sociogeographic perspective, to have some granularity to what they’re seeing.
If you look at most of the data that’s out there, even the Johns Hopkins and Unacast or SafeGraph data, it’s mostly out there in county form, which is fine if you’re interested in the temperature of the pandemic locally, but it doesn’t tell you the weather and how much caution you should be exercising. Right now, that’s not a huge deal, because we’re all being very cautious with our efforts to self-isolate, mask and the like. But as we open up, and we find that our prior efforts burn out and COVID-19 flares up in different spots, we’ll probably have to dial up and dial down and differentiate our self-protective and collective efforts to deal with the virus. As I said, the “1918” influenza pandemic actually lasted until 1921, so it’s like [epidemiologist] Mike Osterholm has said, we need tools to figure out how we’re going to live WITH this virus, since it’s unlikely that we’ll just out and out defeat it–at least, until an effective vaccine is available globally.
AG: You initially launched the app in and for Minnesota, but it’s now available for anyone across the U.S. via auser-friendly website. Do you imagine it could have equal relevance anywhere in the country?
BW: If all the app does is give users good information and maps that convey the details of the pandemic in their neck of the woods, I’ll be satisfied.
But the detailed neighborhood maps that will be produced in the app from new user data will soon be available nationwide. If the data that are generated can be combined with other datasets to get us to a geospatial SEIR model that would allow us to predict more accurately when and where future outbreaks might occur, that would be a real contribution to fighting this pandemic–as well as to science more generally.
Well, it’ll likely only be the former, but hope springs eternal.
N.B. Another version of this post appears on the website of the anthropology journal, Public Anthropologist. You can find it here.
UPDATE, June 19, 2020: Bjorn has just published a co-authored article analyzing changes in the numbers and kinds of patients arriving at ERs in one large, public Minneapolis hospital. You can request a copy here: https://www.researchgate.net/publication/342111120_An_analysis_of_changes_in_emergency_department_visits_after_a_state_declaration_during_the_time_of_COVID-19