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What Anthropology Teaches Us about COVID-19, Part 4: A Conversation with Physician-Anthropologist, Dr. Bjørn Westgard

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Recently, I checked in with Dr. Bjørn Westgard, to see how he was doing.

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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, a Level 1 Trauma Center in Minneapolis that sees 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.

Over the years, Bjørn has researched heart disease among Somalis in Minneapolis (with support from the National Institute for Health); has specialized in hyperbaric oxygen therapy for certain medical conditions; and has helped create an innovative program finding housing and lifestyle amelioration for homeless people in Minneapolis.

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 Westgard here and his LinkedIn page here.)

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 a hemoglobinopathy.  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 for cytokine 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 to syndemic 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. 

Photo by MEGAN JELINGER via Getty Images
A local militia group is seen at a rally to protest the stay-at-home order amid the Coronavirus pandemic in Columbus, Ohio, on April 20. For the third time that week, hundreds of protesters gathered at the Ohio State House to protest the stay home order that was in effect until May 1.
Source here.

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 do case-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 in mobilizing 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, maybe Atmosphere, but not many others in the national mediasphere.

Senegalese group, Y’en a Marre, in a new music video (singing in Wolof) advocating safety measures to protect against COVID-19
Source here

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 a user-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

Academic Career, Anthropology, Biological anthropology, Community, Community education, Covid-19, Creative thinking, Cultural Anthropology, Current Issues, Health care, Health insurance, herd immunity, Humans as a social species, knowledge systems, medical anthropology, Medical issues, Public policy, Research methods, risk, Social justice Read more

What Anthropology Teaches Us about COVID-19, Part 2: An Optimist’s Scenario

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Here’s what I imagine could–and should–emerge from this viral nightmare.

Locally, stranger-neighbors will (re)discover each other. Re-appreciate the bonds of co-residence.

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  • Translate that appreciation into forging new relationships, even new neighborhood groups. Friendly elevator chats, book groups, block parties, children’s after-school clubs.
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  • Remember that our common humanity unites us more than our cultural differences divide us.

Online, new connections and groups will form.

  • In this often scary and lonely world, like-minded folks will find their way online to one another, whether as individuals or in groups.
  • The non-tech-savvy will discover their Inner Geek and figure out how to connect virtually.
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Politicians who specialize in policies of the heartless–generously supporting their own kind, and pretending their ilk have a monopoly on being human–will recover their souls.

  • Re-learn empathy for anyone other than their immediate families and business associates.
  • Translate that empathy for other humans into public policy supporting those other humans.

Globally, political leaders will recognize that it is actually possible to band together with parallel, even coordinated, strategies for the common good.

  • Translate that realization into new, viable policies to counteract climate change.
  • Dismantle the fossil fuel industry.
  • Enact international legislation promoting sustainable energy.
  • Invest in civic-minded engineers and their research.
  • Save the planet.

It’s true that I have a reputation for being a bit of a Pollyana in my family.

Still, even I don’t dare hope that any or all the above will happen overnight. Once the microscopic creatures causing COVID-19 chaos have (mostly) died off, we will need time to remember who we were.

But, also, time to think about who we want to be.

This horrible moment provides an important opportunity for us—as individuals, as communities, as nations, and as a globalized species—to rethink, well, everything.

Climate change, Community, Cooperation, Covid-19, Creative thinking, Cultural Anthropology, Empathy, Environmental anthropology, Environmental issues, Fossil fuel industry, Humans as a social species, Politics and society, Public policy Read more

What Anthropology Teaches Us about COVID-19, Part 1-Early Thoughts

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Lesson 1:

Like the ducks and brants my husband and I see congregating regularly by the dozens along the shore’s edge of Narraganssett Bay near our coastal home, we humans are a social species.  (Audobon’s description of the Brant: “Feeds in flocks at most times of year”),

Whether indoors or out, whether in small numbers or large, whether in person, online, or at a distance, we crave others.  And not only for emotional needs.  Also, for economic and survival reasons.  With precious few exceptions, we modern humans haven’t survived the past ~100,000 years as hermits.

So, it’s no surprise that, when the bizarre daily habitus of “social distancing” becomes the “new normal,” we suffer.  We were meant to.

Lesson 2:

Like the Leonardo da Vincis or Zora Neale Hurstons we read about in chronicles of our most creative ancestors, we humans are a clever species.

Okay, so, we’re not all Albert Einstein or Sappho.  But, whether working at an easel or a computer, whether laboring alone or in a team, whether doing work of the mind, heart, or body, we specialize in problem solving.  We haven’t survived the past 100,000 years as modern humans by walking over cliffs en masse as lemmings do when they run out of choices. 

Yes, life and society have apportioned privileges unequally, contributing to unequal doses of resiliency at the individual level.  That is a heavy burden that psychologists specialize thoughtfully in addressing, even as our politicians ignore their responsibility in producing the structural inequalities that create such unequal apportioning. Once we emerge from this global crisis, even our most heartless politicians should have greater awareness of what it takes at the structural level to sustain a compassionate community.

For now, it’s important for all of us to remember that, collectively, we are a resilient lot.  Unlike every other species, we’ve figured out brilliantly how to safely move through, and even inhabit, every environment on earth, from sky to water, from arctics to tropics. 

Now is not a time for despair. The tiny creatures underlying today’s global crisis will not defeat us.

Lesson 3:

The bad news:

Coping with COVID-19 won’t be fun.  Some among us will suffer more than most—financially, emotionally, logistically. 

Those who survive on daily coffee and lunch dates, and weekly dinner parties or movie outings, may become especially frustrated and depressed.

A very small number of those among the most vulnerable of us–especially the elderly, those with compromised immune systems, and those in both categories–will not survive a viral attack.

That is a potential source of collective tragedy we must all work hard to mitigate.

The good news:

We are learning to thoughtfully prioritize scarce resources, with the greater good in mind.

Face masks are for front-line health workers, and for those with disease symptoms, to prevent them from spreading disease when they must go out and about.

Some stores are limiting the amount of COVID-related items they’ll allow shoppers to buy. Hoarders of masks and toilet paper are being shamed in cartoons, and warned everywhere to change their behavior.

Individuals aren’t the only ones being monitored. Stores are, too.

New York City has already issued $275,000 in fines to stores that have charged more than 10% higher-than-usual prices on hand sanitizers, disinfectant wipes, and face masks. The fines will apply for at least two months.

The community spirit being promoted by this pandemic has other positive effects. For those with Internet access at home, social media offer us amazing alternatives for remaining in touch with those near and dear to us. They also help us find our way to many new communities that can offer solace.

In the U.S., for those with limited Internet and data access, new options are emerging daily to provide access. Companies are actually offering expanded smartphone data at no charge, creating new Wi-fi hot spots, and offering free international phone calls.

No doubt, these profit-oriented corporations will return to greedy practices once the pandemic subsides.

But for now, at least some of them are actually being part of the solution. Their unusual pivot reminds us that, as a species, we will survive this challenge, as we survived all known pandemics—the Black Death, HIV-AIDS, Ebola and others.

Not only that, but if we live up to our vaunted cleverness, we may actually emerge stronger.

The moment will produce many heroes.  

Front-line health staff will bravely reduce the suffering of patients. 

Humane politicians will offer financial supports.  Germany has “promised companies ‘unlimited’ credit to keep them afloat” in an economic package . . . worth at least 550 billion euros ($614 billion) initially — the biggest in Germany’s post-war history.” Politics will even make strange bedfellows. Mitt Romney has just endorsed Andrew Yang’s proposal (at last for now) for a universal basic income.

Brilliant infectious disease specialists will analyze all available data and translate statistical and arcane knowledge into readable syntheses for ordinary readers.

Medical researchers will eventually create a vaccine.  The EU has already invested an emergency $89.4 million into the project.

And those are only the headline heroes.  We will have far more heroes who will never make the headlines.

On my neighborhood list-serv, someone who loves to cook has offered to bake a loaf of bread, and personally deliver it on foot, to any elderly or quarantined neighbor who requests one.  To be realistic, she clarified the approximate radius of how far she might walk to deliver samples of her kitchen’s output. Another neighbor soon magnified the offer: he’ll drive to pick up the loaves and deliver them by car to anyone farther than the generous baker’s walkable zone.

And that was only Day Two since my state’s governor declared first steps of “social distancing.”

Not convinced of our species’ capacity for creative and even limitless commitment to one another, no matter how far the physical distance required?  Check in soon for more encouraging ethnography, large and small.

Meanwhile, remember: As a species, we’ve got this.

Anthropology, Community, Cooperation, Creative thinking, Empathy, Ethnography, Germany, Human evolution, Humans as a social species Read more

Environmental Anthropology: An Ethnographer’s View of a Cove Cleanup

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The curse of the anthropologist: finding culture everywhere in nature.

Publicly posted signs reinvent the medieval European town crier, or the West African village drummer

 

Today, the coastal neighborhood in which my husband and I now live hosted a cleanup in a nearby cove.

 

Of course, this effort was billed as an environmental event. But whenever I bent down to pick up a piece of blue plastic poking up from the sand, or a shard of brown glass glinting under the noonday sun, I couldn’t help thinking of the organization of labor required by clever humans to lug this alarming collection of detritus to a landfill.

 

 

Or perhaps a container ship will transport the bags of sea trash halfway around the world. Someplace in China, rural-to-urban migrant laborers might pick through heaps of American scrap and send the sorted pieces to factories in Shenzhen or Dongguan. There, other rural-to-urban migrant workers (of the sort profiled by the fascinating book by Leslie Chang that I am currently reading, Factory Girls) will make new products from recycled glass and bits of plastic. Maybe next year, those products will make their way on new container ships headed back to the Port of Providence, right up the road from us. And then, I might buy a set of drinking glasses or a plastic spatula at the local mall that boasts, “Made in China.” Was it really? Our work today suggests that such a label might tell only a very partial story.

Or so I fantasized, as I picked out crushed straws and dirtied pencil stubs from the wet sand and stuffed them in my rapidly filling trash bag.

Enjoying a beautiful day for a clean-up; photo by Philip Graham

 

As I joined in today’s collective effort, my mind wandered back to an annual community cleanup that occurred in the small villages of the Beng people in which my husband and I have lived for long periods in the rain forest of Ivory Coast. There, the male chief of every village organizes the event. The goal: to sweep the paths clean that connect village and forest. Farmers walk these paths daily to reach their fields, which are located deep in the heart of the West African rain forest. It’s important to keep the paths clear–otherwise, inattentive farmers worried about this year’s rainfall might forget to look where they’re stepping and tread on a poisonous millipede, a scorpion, or a snake.

Beng villages are designed as discrete clearings in the surrounding rain forest; photo by Philip Graham

 

Once those paths into the forest are cleared, the residents tackle the village itself. The goal: to clear every blade of grass, so no child inadvertently steps unsuspectingly on a green mamba hiding among tall plants while walking to Grandma’s house.

A Beng chief’s word is next to that of god. Beng chiefs are said to use witchcraft to protect their villages, and no sane person would dare deny their annual order to sweep the paths.

A young Beng man sweeps in front of the assistant chief (seated, with a white shirt), while behind him, his older brother, the village chief (seated, with a long, light blue robe) looks on, approvingly; the space is being cleared before a village meeting is convened

 

Moreover, these chiefs occupy a hereditary position. Sure, villagers might dispute the suitability of this or that genealogically qualified candidate, after a particular chief dies. But the basic system offers an official and more or less predictable structure into which individual successors can be slotted.

The neighborhood in which my husband and I now live in Rhode Island lacks such an inherited leader. So how does our annual neighborhood cove cleanup get organized?

As it happens, one woman named Barbara Rubine occupies something of a chief-like position.

Barbara Rubine (left) oversees today’s cove cleanup, along with Andy Gell and Mark Garrison, two Board members of the Edgewood Waterfront Preservation Association 

 

Living across from the cove motivated her to start thinking clean-up thoughts some thirty years ago, when the discouraging view out her window featured more rubbish than river. To maximize her efforts, she founded the Edgewood Waterfront Preservation Association, of which she remains president. As the city of Cranston noted when it voted to commend her for work in 2013, Rubine has “coordinated park maintenance, and shoreline and marsh restoration work with the National Oceanic and Atmospheric Administration, the Natural Resources Conservation Service, Save The Bay, EWPA and the City of Cranston.”  Which is to say, she’s helped secure major grants from the U.S. Environmental Protection Agency as well as local organizations.

Yet, from what I can tell, many volunteers at today’s cleanup don’t know this energetic and visionary woman–even though she is, herself, a veritable force of nature. No, it’s not Barbara Rubine’s moral authority that draws groups of neighbors to add their e-mail address to a list of volunteers, study a long list of labor-intensive tasks, then grab trash pickers and leaf bags and get to work.

 

 

Environmental activist groups sponsoring the clean-up requested e-mail addresses to recruit volunteers for future tasks, then provided supplies for all volunteers to use

 

It must be some collective sense of purpose that, despite its amorphous shape, draws individuals here.

Dean’s grandfather

 

Moreover, many parents clearly aim to model civic engagement for their children.  After all, it takes a village to maintain our neighborhood cove–which, as my five-year-old grandson Dean proclaimed last year (following a tour of Rhode Island’s magnificent coastline), is, after all, “the original, the best, and the most beautiful cove.”

       

 

 

 

 

 

 

 

 

 

 

 

 

And so, behind all this laudable effort to preserve the habitat of shellfish beds in their vulnerable corner of the natural world, the structure and motivation of the human labor on behalf of the mussels somehow claim most of my attention.

Fragile mussel beds benefited from the housekeeping efforts of their human friends

 

The curse* of the anthropologist, indeed.

 

* or blessing

 

. . .

 

[All photos by Alma Gottlieb except where noted.]

 

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Doing Development the Right Way: A Conversation with Charles Piot

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Anthropologist Charlie Piot has been conducting research on the political economy and history of rural West Africa for over thirty years. His first book, Remotely Global: Village Modernity in West Africa (1999), has gained wide attention for re-theorizing a classic, out-of-the-way place as existing within the modern and the global.

 

His next book, Nostalgia for the Future: West Africa after the Cold War (2010), explored shifts in Togolese political culture during the 1990s, when NGOs and charismatic churches reorganized social and political life in the absence of the state.

His current project focuses on Togolese who apply for, and attempt to game, the US Diversity Visa Lottery.

You can find out more about Charles Piot’s work on his Duke University website here.

While pursuing his own research in Togo, Piot now brings undergraduate students from his U.S. campus (Duke University) for short stays in the West African villages of the Kabre people where he has made a second home.  While there over summer and winter breaks, the students have developed and pursued their own, small-scale development projects.  In developing these projects, the students aim to tap into both their own skills and the needs of the villagers.

Neophytes are notoriously doomed to fail in such culturally and politically sensitive work. But these students are lucky to have Professor Piot to guide them in the exceptionally thoughtful and informed way that anthropologists do best.  Many of the projects have already proven transformative, while the failures have proven instructive.

Piot has worked with the students to publish a striking collection of essays chronicling their efforts.  The result: Doing Development in West Africa: A Reader by and for Undergraduates (Duke University Press, 2016).

Anthropologist Brad Weiss calls the book “an innovative . . . eminently readable and teachable text valuable to courses in international relations, political science, and anthropology.”

The book was “Highly recommended” for libraries by Choice.

Recently, Charlie and I had a conversation online about the book.  During part of our conversation, Charlie was actually back in the villages, checking up on recent projects and tweaking them to make improvements.  I think you’ll find the conversation fascinating.

CP: Charles Piot

AG: Alma Gottlieb

 

AG:  This book features projects that your undergraduate students at Duke have undertaken in a rural area of Togo where you’ve conducted research among the Kabre people for a few decades.  What inspired you to compile a book of essays by and about research in West Africa done by American undergrads?

CP: The idea for the book was entirely student-driven!  One year’s group of students with academic leanings – all three went on to graduate study, with one now pursuing a PhD in medical anthropology – asked if they might write up the results of their summer projects in an Independent Study class.

I agreed and put them through the paces – first week, produce an abstract; second week, an Introduction; and so on.  Before you knew it, they each had short articles, which were surprisingly strong.  One of the students asked if we couldn’t try to publish them, and of course I said, “Sure”–while secretly imagining that we’d end up publishing them on a website of our own design.

But one thing led to another.  We added more essays the following year.  We found some money to fly in to Duke an anthropologist (John Hawkins) who had published a similar book of student essays, and he gave us outstanding editorial advice.  We had lunch with a Duke University Press editor who was super-supportive of the idea – for him, it was a novelty, a book by undergraduates for undergraduates about development – and said he’d send the essays out for review.  But then, of course, the real work of producing a book – of editing and fitting all the pieces together – began.

Then, too, the projects themselves have always drawn me in.  These projects – all, student-designed – are interesting and doing important work in the villages.  And they tell interesting cultural stories.

Recipient of the Writer’s Collective Award for Best Poem (with a Duke Student), in a Kabre Village (Togo)

 

Finally, the problems and challenges of development in West Africa are vexing and fascinating.  I didn’t used to think so.  In fact, in years past, I would run the other way when I saw a development worker.  But now I find issues of development not only urgent but also (as Lévi-Strauss might have said) “good to think with.”

2017 Group of Duke University Students in a Kabre Village (Togo) 

 

AG:  Let’s start with that last comment.  As an Africanist, I spent three decades lecturing to students about the failures of large-scale “development” programs across Africa.  I suspect you did, too.  Yet we both find ourselves now working with small-scale “development” projects in our fieldsites.  Or maybe, it’s because we found so much wrong with those large-scale programs that we’ve both now embraced much more local, small-scale projects, in spaces we know well.  (Your work with these projects in Togo is exactly why Philip Graham and I invited you to join the Advisory Board of the Beng Community Fund that we founded, to create small-scale projects with Beng villagers in Côte d’Ivoire.)

In helping your students design their micro-projects, do you find yourself thinking explicitly about the failures of so many past IMF (etc.)-funded projects in Africa, and working with these students to design projects that will avoid those well-documented problems?

 

CP: Everything we do in Togo is tied to the spectre of development’s many failures that you reference.  My own feeling is that many of those failures, whether large-scale or small, are due to the failure to understand or engage with local culture.  How can you introduce new systems of debt (that come in with a microfinance project) if you don’t understand local notions of debt?  How can you design farming or health projects if you don’t understand local labor and cultivation practices, the way gender and labor intersect, and even local conceptions of the body?  But, astonishingly, most development projects never get down in the weeds of the local like this.  They assume the benefits of their projects will be obvious to all.  So they hire technicians and economists and agronomists, who are all well-versed in the Western sciences—but, rarely, anthropologists!

All of our projects in Togo – a microfinance opportunity for teens, a village health insurance system, computer classes, a writers’ collective – attempt to draw on local knowledge from the get-go, from design to implementation.  If we’ve had any success at all–and I believe we have– it’s because of our attention to local culture and history.

But there are no guarantees!  Indeed, as a provocation, I tell the students they shouldn’t get their hopes up too much, they should remain humble (and assume that locals know much more than they do – about farming, their bodies, local institutions), and even expect failure.  But such failure can be instructive in informing future efforts.

Another blind spot of many development projects is sustainability and follow-up.  Do they ever think about the time, five or ten years down the road, when the outside director or project manager will no longer be there?  Usually not.  This is a topic I’m preoccupied with right now.  What will happen to these projects after I stop taking students to Togo?  And what happens each year after we leave?  Do the computer classes live on, does the microfinance project continue to function?  I’m actually in Togo right now for a few weeks for that very reason, to follow up on all of the projects and continue to brainstorm the question of sustainability.

Charlie Piot Drinking Sorghum Beer with a Local Chief in a Togolese Village

 

AG: That’s fantastic that you’re writing about this from the village–using Internet supplied by one of your students’ projects.  That would certainly be one of the success stories.   Can you talk about the projects that have been the most–and least–sustainable?  In the case of the projects that are faltering, are the obstacles more technical, or sociological, or economic, or emotional . . .or a combination of some or all the above?  Are there things you now realize you could do in the future to make new student projects more sustainable?

Wireless Relay Station outside a Kabre Village (Togo) Demonstrated by Duke Student

 

CP: A nice question!  I’ll respond by discussing two examples of projects of ours that have had mixed success.

First, the health insurance system we’ve set up in a village clinic.  With this project, member families get free consultation and pay 25% the normal cost of medications, all for $4 a year per family.  The project has had fluctuating membership since it began 10 years ago, with only 25 families out of 200 currently enrolled.  And this, despite the fact that all insurees are unanimous in their praise of the benefits of the system.  Every year, we interview members and non-members to try to get to the bottom of why more families aren’t signing up.

Some of their responses: the health insurance scheme requires payment on a schedule, while the local system of payment and debt is more accommodating to unforeseen contingencies; the indigenous system of medicines is also efficacious and cheaper (you never “thank” a healer until after you are cured, with payment in kind – some beer, a chicken); some worry that paying for a cure before you fall sick might (through mystical means) bring on the sickness; others want to know if they can get their money back at the end of the year if they never attend the clinic.  All these responses make us realize how culturally shaped the idea of “health insurance” is!

The second example involves the cyber café.

                Muddy Flip-flops Left outside the Entrance to the Kudwe Cyber Café                          in a Kabre Village (Togo)

 

The computer classes we’ve offered while we’re there have been wildly successful.

Schoolroom Chalkboard Demonstrating the French Keyboard in a Kabre Village (Togo)

And we’ve found a high school student, a real wiz, who took our classes, to teach them to others after we left.  That could make the project sustainable beyond our presence.

Students inside Classroom in a Kabre Village (Togo)

But last month, when I was visiting the villages, I discovered that the cyber café has been closed to classes since we left last August, because the person responsible was transferred to a town fifty miles away,  and the person taking over hasn’t yet done what they call a “transfer of power” (passation de service), because no one has yet compiled an inventory of the materials in the cyber café.

So, as you can see, these are not technical problems–they’re social and cultural.  And while both projects are “successful” – the health plan works well for some families, and we’ve taught computer and Internet skills to several hundred youth in the villages – they’ve nevertheless fallen short of realizing their full potential.

 

AG: You’re unusually honest in assessing the weak spots of promising projects. I’m guessing this is because your training as an anthropologist compels you to see the social fissures that are invisible to the directors of so many large-scale development projects, who often focus on the technical components alone.  Our propensity as anthropologists to see the invisible but powerful lines of the social universe may make it easy for us to spot problems that elude the gaze of others.

But, does that skill also enable us to fix the problems?  For example, once you discovered the personnel problem with the cyber café, did you perceive any viable way to tackle it?

The insurance situation strikes me as even more challenging, because there, you’re dealing with a clash of values, and that’s almost always far trickier to address than other challenges.

Thinking about both these projects–with their encouraging yet mixed successes–I wonder if you have thoughts about how the next group of Duke students you bring to Togo might brainstorm solutions that could further address this thorny but critical question of sustainability.

CP: I do think our training as anthropologists aims our attention to the social life of communities, with all its messiness and conflict and fissure.  Do these insights also enable us to find solutions to the problems of development in small-scale contexts like this?  In principle, yes.

To stay with the example of the cyber café we’ve installed: despite the frustrating loss of time – eight months of inactivity – my students and I have familiarity with the lines of authority at the cyber café and in the larger community, and we know what jealousies might be in play—so we are able to brainstorm solutions with local allies.

In this case, a promising outcome is in progress – and one that may vault the cyber-café into a whole new orbit of activity, with a private entrepreneur from a different ethnic group managing it, while adding a photo-copier and printer, and installing a money transfer kiosk. (Local wisdom is to go outside the community to look for a manager, as locals might attempt to poach on the goodwill of a family member or close acquaintance, quickly bankrupting the enterprise.)  So – perhaps!  Only time will tell if this will be a failure-into-success story.  If it does, even a success will surely generate its own new round of challenges and setbacks.

But, development in such a context is always like this.  If we’re lucky, we might take three steps forward for every two steps back.  And, in any case, staying with the challenges has its own rewards.

2017 Teen Microfinance Awardees (and Family Member Guarantors) in a Kabre Village (Togo)

 

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Everything You Thought You Knew about Orphans in Africa Is Probably Wrong

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Policy makers, development workers, orphanage voluntourists, missionaries, prospective adoptive parents: ignore this book at your peril.

Crying for Our Elders-Front Cover

 

“AIDS orphans” are commonly imagined as the most vulnerable of the world’s most vulnerable populations.  In a provocative new study, anthropologist Kristen Cheney  challenges just about everything we thought we knew about the children of Africa who have been labeled “orphans.”  Along the way, she decries what she terms the new “orphan industrial complex.”

Crying for Our Elders: African Orphanhood in the Age of HIV and AIDS was recently published by the University of Chicago Press (2017).

In a pre-publication assessment, distinguished anthropologist Didier Fassin has written:

“Through her cautious, insightful, and moving ethnography based on fieldwork in Uganda, Cheney provides a deep understanding of the complex and unexpected forms of life that emerge around orphans. An important contribution to the growing field of critical children’s studies, Crying for our Elders is also a remarkable expression of ethically engaged anthropology.”

And in an early review, Rachael Bonawitz has written:

This abundantly researched work is essential to the study of international development and of orphanhood, as well as an enriching contribution to the field of children’s studies.

You can find a Table of Contents here.

Read excerpts online here.

The publisher offers complementary desk/exam copies to instructors here.

From the website of the Institute of Social Sciences/Erasmus University-Rotterdam (where she is Associate Professor of Children & Youth Studies), you can find Kristen Cheney’s institutional home page here.

At the recent conference of the American Anthropological Association (held in Washington, DC in December 2017), Kristen Cheney and I recorded a conversation about her new book.  Here’s what Kristen had to say (AG = Alma Gottlieb; KC = Kristen Cheney):

Kristen Cheney, Headshot

Kristen Cheney

AG: What gave you the idea to write this book?
KC: I had done fieldwork with children for my dissertation, which became my first book (Pillars of the Nation: Child Citizens and Ugandan National Development, University of Chicago Press, 2007).  In the process, I came across a lot of kids who were orphaned.  I was working at schools, so I’d often come to a primary school and have kids approach me—at least once a week—and give me letters, because they were too shy to talk to me directly about their situation.  A lot of the letters described their circumstances and asked for assistance—primarily, educational sponsorship.

In one instance, a girl came up to me one Monday and said that she lived with her aunt and uncle, and over the weekend, her uncle—who was her blood relative—had died.  Her aunt-by-marriage said, “You can continue to live here, but with him gone, I don’t know how long I can keep you in school, because I have to prioritize my own children.”  So by Monday, the girl was already coming to school and saying, “I’ll find the mzungu”—white person or foreigner—“and ask them if they can help me.”  That kind of thing happened fairly frequently.

So I decided the next book would look into how children experienced and understood orphanhood—as well as the broader purview of humanitarian responses to orphanhood, and how they either help or hurt those situations.

 

AG: That raises methodological issues.  In the book, you talk about adapting participant action-style research methods with children.  That’s a kind of research that’s become very popular in other disciplines, though we don’t call it by that name in anthropology.  Can you talk about the difference that this research method makes to working with children in this kind of project?

KC:  For what I term “youth participatory research,” the benefits were several.  I wanted continuity with some of the kids I’d worked with before.  My youth research assistants for this project were the young people who I’d worked with and had done life histories on for the first book.  So there was some continuity, because part of the purview of the book was mapping generational experiences of the HIV/AIDS pandemic onto different developments in the fight against AIDS.  These kids were born around the time of the “prevention of mother-to-child transmission” initiative, which meant that a lot of the kids who might have died from having gotten infected by HIV survived.

But their parents still often died when the kids were quite young.  So they were one sub-generation, in their teens by that time.  I wanted them to work with some of the younger kids who were 5-10 years old—kids of the post-ARV generation, for whom anti-retroviral (ARV) drugs had become much more available.

 

The post-ARV generation

 

Some of the teens had experienced these kinds of issues surrounding orphanhood themselves.  Some of them weren’t full or double orphans—some had lost one parent, some had lost both, some hadn’t lost either parent but had still struggled a lot.  So they were in a better position to work with the younger kids, by being closer in age, and having grown up in the same kind of society, facing the same kinds of issues.

Youth Research Assistant Works w His Group

 

A youth research assistant (right) works with his focus group, 2007

(photo by Kristen Cheney)

 

There was also a pragmatic element.  Being based in the US at the time, I’d be in East Africa for a while, or for a summer, and then I’d have to leave.  With this method, the youth research assistants could be visiting these kids with whom we’d matched them–visiting them in their homes or schools once a month, and talking about how it was going–and we’d get a broader sense of their lives, without me having to visit 40 different homes.  We could cover more ground that way.

I don’t want to claim a representative sample, but we could get a broader picture of what kids were going through.  That worked fairly well.

The down side is that this method takes you out of the field.  You have to yield your expertise and your authority, and make space for that to happen.

You have to yield your expertise and your authority.

I became a bit of an administrator rather than a direct researcher.  But when we had workshops together and compared notes and we asked, “What do we make of that?” it was much more participatory, and formulative of some of the broader arguments.  We’d decide as a group, Where do we probe further, and where do we go deeper into certain kinds of issues?

The research itself becomes transformative.  If you’re really interested in these issues, and you want to study it to help change something, and fulfill a sense of social justice, you start to see change within the community.  The younger children saw the youth research assistants as older brothers and sisters.  They became very close.  The young children would tell the youth researchers things that they would not tell anyone in their own family, and voice some things they didn’t feel they could voice, especially about loss—saying, “No one’s telling me what’s going on.  They think they’re protecting me, but I want to know.”

We really had to think about how we handled that relationship very carefully—think together, How do we counsel these kids?  Because the youth research assistants became mentors to those kids.  It was also transformative of relationships in the community.

I’ve done a lot of other youth participatory research projects since, and we’ve seen the same things happening.  Right now, I’m doing a project to study adolescents’ understandings of healthy relationships, for the Oak Foundation.  The work is supposed to help in the Foundation’s advocacy in preventing child abuse.  We’re doing that project in Tanzania and Bulgaria.

Youth Peer Researchers-Oak Fdtn ProjectYouth peer researchers in the Oak Foundation project on Adolescent Perceptions of Healthy Relationships, 2017 (photo by Kristen Cheney)

Now we have youth peer researchers who are as young as 10 years old!  I had a conference call—what they call a “learning call”—with some of the Foundation team, and I was describing the progress of the project.  They were already on board with the participatory method, so there was no having to convince them of its value, which was nice—because sometimes, you have to do a lot of convincing.  They said, “We’re really anxious to hear how your results will help our advocacy.”

And I said, “We can talk about that—but I want to be clear that our approach is that research IS advocacy.  We’re already seeing transformation in these kids, and the way that they talk about how, under the aegis of the research, they’re able to talk to adults across generational divides about things that they otherwise aren’t able to talk with them about.  Those adults come to see them differently, because they become informed about certain ideas and start to possess certain knowledge such that people start to see them differently. It raises their status.

So we’ve already seen a lot of transformation happen—between the kids we’re working with and their peers, and also other interlocutors in the community.

So I said, “It’s not research then advocacy; research is, in itself, a kind of advocacy.”

And they said, “Oh, okay.”  They hadn’t thought of that.

We have youth peer researchers who are as young as 10 years old!

 

AG: That raises another question.  Can you talk about how you compensate the youth researchers—whether financially or in other ways?  Because that’s a mode of doing research that may be unfamiliar to some anthropologists.

KC: Even working at ISS, a development studies institute, we work a lot on “capacity building” with non-academic development partners, and we’ve also talked with them about this.

We agreed that it doesn’t work well to do cash compensation with young kids.  It creates a perverse incentive, in a way, and doesn’t lead to quality research.  But there are other, non-cash incentives.

In the case of Crying for Our Elders, I helped the youth research assistants with school fees.  But it wasn’t conditional.  I said, “It would be great if you would help with this research,” but it wasn’t either a carrot or a stick.  They were happy to help with it.  I met with them before I published the book, a few years later, and had them reflect on the experience.  It was interesting for them to talk about that.  That issue of compensation came up, the ways that they gained skills—whether they were directly applicable in their professions as they got through school and went on, or just interpersonal skills. It was really rewarding to see.  That’s the sort of incentive I wanted to create—I told them, “You’ll build your skills, and they’ll be marketable skills.”

When my colleagues and I were doing a project for Save the Children that also used youth participatory research methods a few years ago, we trained almost 100 peer researchers in Uganda and Ethiopia.  None of them dropped out, unless their family moved.  But none of them said, “I’m bored” or “I’m not earning anything” or “It’s not helping me.”  They all stayed with the project for three years.  The idea that kids will be flighty and just leave is not necessarily true.

We trained almost 100 peer researchers in Uganda and Ethiopia.  None of them dropped out.

In our last workshop, we asked them to reflect on how they experienced the study.  We had them draw pictures of their journeys within the research project.  Some drew mountains, and some drew rivers with bends in them; there was always some sort of apex or obstacle to overcome.

One young man drew a bus and said, ”I feel like the bus is coming out of the woods and into the city.”  Basically, he was talking about the process of participating in the research project as enlightening.  Then he said, “The forest is illiteracy and the city is literacy.”

Youth Peer Researcher-Save the Children Project

 

A youth peer researcher for a Save the Children project sharing his research journey, 2016

(photo by Kristen Cheney)

 

He also spoke really movingly about how the research group had become like a family to him by the end of the project.

 

AG: You had meetings for everyone?
KC: Yeah, we had workshops where we got together a lot.  But they would also go out and do data collection in pairs, or they’d do interviews or focus groups together.  And they had a lot of support at different levels.  All of them said, “We feel like it’s a family now.”  And they said, “We’ve learned how to talk to adults about things that had been taboo, or difficult to talk about—and even how to talk to adults, more generally.”  For me, that was rewarding in itself.

Youth Peer Researchers in Ethiopia, Save the Children Project

 

Youth peer researchers (left and right) for a Save the Children project in Ethiopia engage with their supervisor (center), 2016 (photo by Kristen Cheney)

 

For that project, we’d also brought a lot of swag and bling from my institution (the Institute of Social Studies in The Hague)—backpacks, pens, trinkets that said ISS on them, and so on.  Every time I came to a workshop, I’d always have a bag or hats or whatever.  But the one thing that was really special to the kids was getting a certificate.  Early on, they’d even asked, “Will we get a certificate for participating in the project?”  Because certificates really mean a lot to them as they’re building a professional portfolio.  Even if they were still figuring out what they wanted to do when they grew up, they knew they’d always have that certificate that said, “I participated in this project, and I did research.”  They were more eager about that than they were about the other stuff we’d bring them.  They thanked us for the backpacks, but when you gave them that certificate, they were so, so thrilled by it!  It became a career-building sort of thing.  That was the thing that was really important to them.

 

Youth Peer Researchers w Backpacks, Certificates

Youth peer researchers with their backpacks and certificates (Uganda, 2015)

(photo by Kristen Cheney)

 

I’ve also given certificates to some of the youth researchers who helped with Crying with Our Elders.  When I met them years later, they said they’d saved their certificates.  One of them even reached into his bag and pulled out his certificate that I’d give him almost ten years before.  He’d had it laminated.  Another one said, “Mine got wet and got destroyed, and I was going to ask you for another one.”

It’s not about, necessarily, financial incentives.

 

AG: In effect, the certificates, and what they represented, became a sort of intellectual capital.

KC: Yeah, it’s helping them see the long view of how the research project might help them with making connections with people, because we were working with local development organizations—ones that did the research and training.  So it’s connecting them.  They saw the value in the social connections and the skills building, and that was enough in a lot of cases.

 

AG: In choosing youth researchers, were you looking for students who seemed to have particular intellectual capacities?  Or was it the opposite—those who seemed to need the most help?  Or, something else?

Youth Peer Researcher, Jill

 

Youth research assistant, Jill, reporting at a project workshop, 2008

KC: In Crying for Our Elders, I returned to work with kids I’d worked with earlier, when they were younger.  Some of them were quite strong as students, but some of them weren’t.  That could become a bit of a challenge in this project.  For the workshop, some of them were keeping very detailed notes and journals.  But one of them just didn’t like to write, and just wouldn’t do it—he refused to write.  I would say, “If you go into the field and don’t write anything down, it’s like you didn’t do it.”  That didn’t compel him to write anything down.  But he was a talented musician who really liked to work with audio equipment.  So I said, “You have your voice recorder.  You’re turning it on to talk to the kids.  Just keep it on and take notes—do verbal notes.”  And he said, “Oh, okay, I can do that.  I can just speak into the thing.”
AG: I do that often myself, when I’m driving away from an interview.

KC: Right. So you work with where they’re at.  Others were very good about keeping notes.   But that’s obviously not the only way to do it, and we sometimes tape fieldnotes ourselves.

I had another youth researcher who was really enamored of the video camera.  I just said, “Take the video camera and run with it.”  And he’d do that.  He’d get all this nice footage of the kids and use it as documentary evidence.

In this more recent project, one of the examples I gave to the Oak Foundation of the advocacy issue is, when we had our first workshop after the kids were recruited in Tanzania, we had one kid who was no longer in school.  She was a 14-year-old girl and seemed very shy, almost mortified by everything that was happening.

Sometimes we’d say, “Everyone think of three things and write them down and we’ll go around and share them.”  And we’d come to her and sometimes she’d be physically hiding her face, as if she didn’t want to be called on.  At first, we started wondering if she really wanted to be there.  By the end of the day, it started to dawn on us that we were asking them to do a lot of reading and writing, and she couldn’t read or write.  She’d gone to two years of school and dropped out.

My local project leader said, “I don’t know how she’s going to do the survey if she doesn’t know how to read or write.”

But I said, “No, let’s not push her out.  There’s a reason she’s here.”

We discussed this with her, and she said, “Don’t make me leave.  I’ll come tomorrow with a friend who can help me.”

I said, “She can reach people we can’t reach.  So let’s not exclude her because she doesn’t have these skills.  We can find other ways around this.”

And she was saying, “I can find other ways around this.  I’m willing to improve in order to be involved.”

So I said to the local project leader, “Let her stay.  She could be the most transformed by this project.”

The next day, she came with a friend and was much happier to participate.  I think partly she had just been worried that the other school-going kids would tease her.  When they didn’t do that, she settled down and stopped excluding herself and started to join in.

We have these “circles of support,” and we said to the supervisor in the closest circle, “Can you help her find an adult education class nearby?”

Three months later, when I checked in, the local leaders said, “She’s already vastly improved in her reading and writing, because she wants to participate in the project.”

So we’re already seeing that transformation happening.

 

AG: That’s awesome.  You’ve talked about advocacy and social justice.  You’ve mentioned that research itself can be a form of advocacy.  Beyond that, can you talk about what would be your best-case scenario if policy wonks interested in the HIV and/or orphan crises in Africa were to read your book?  What would you want them to do differently?

KC: What we’re seeing now is people acknowledging that the traditional family system in Africa has largely weathered the storm of HIV/AIDS orphanhood and taken those kids in.  But what we’re also seeing is people picking up and running with this very broad definition that UNICEF has of orphans—that an “orphan” is any child who’s lost at least one parent.  That’s become a justification for a lot of private donations, particularly, to orphanages (along with some public investment in them).  We’re suddenly seeing a mushrooming of orphanages in Uganda and other places.  This is what I’ve been talking about in lectures I’ve been doing recently—what I call an “orphan industrial complex” that’s come out of this desire to help orphans, and thinking that orphanages are the best way to do that—but they’re not.  It also comes out of the growing popularity of what’s now called “voluntourism,” and working with children has particular purchase with people.  They see orphans as the most vulnerable children, so people say they really want to work with orphans.

 

Proliferation of Orphanages in Uganda

Proliferation of orphanages in Uganda since the height of the AIDS pandemic (bit.ly/orphanindustrialcomplex)

I’m really challenging that sort of “child rescue” discourse that’s actually jeopardizing children and breaking up families and causing unnecessary institutionalization, because they’re building orphanages and pulling kids into them.

In short, I would like to see an end to orphanages in my lifetime, and I think that’s quite possible to do.  Instead, we’re seeing a real increase in orphanages, because people who think they’re helping are setting up new orphanages without realizing this broader picture.

“I would like to see an end to orphanages in my lifetime.”

First of all, from 60 years of child development research—which a lot of the donors to orphanages haven’t read— we know that orphanages are not good places for children to grow up in.  A lot of this comes from faith-based communities.  They’re talking about the Biblical command to “visit orphans and widows in their distress.”  Somehow, the widow falls out of the picture very quickly, because there’s a much more emotional purchase in the orphan.  A lot of these people don’t have backgrounds such that they would investigate this history or this research in the child development literature.  “Child rights” isn’t in their vocabulary.  “Child protection” isn’t in their vocabulary.  So it can be very difficult to break through this idea of, “I’ve always wanted to go to Africa and start an orphanage.”

 

AG: Or maybe they perceive the “child rights” and “child protection” discourses in very different ways that make it look as if they’re actually doing everything they can and should do to help?

KC: Right.  But it comes from a very different register—either this spiritual idea, or from “voluntourism” and service learning, on which there’s been a lot of good critical literature coming out stating that that sort of transformation is much harder than something you can accomplish while backpacking.  The supporters of orphanages don’t often think through some of the issues I’m trying to raise.  This is not about the supply of orphans, this is about the demand for experiences with orphans.  We’re actually causing orphanhood, de facto.

“We’re actually causing orphanhood.”

Locally, what’s happening is—if you build an orphanage in a poor community, kids will come.  But they’re not coming because they’re orphans—they’re coming because they don’t have access to schooling, and recruiters are going into the community to entice families to institutionalize their children in order to access education.  That’s the #1 reason we’re seeing why families are being induced to put their kids in orphanages.  To the local community, it’s often presented as free schooling!

 

AG: So, to the policy wonks, maybe your big take-away point would be, “Don’t build orphanages; build schools”?

KC: Yes, in some ways.  The main goal should be: improve educational access.  Don’t support orphanages.  Don’t build them.  Don’t visit them.

I’ve actually been working with a group called Hope and Homes for Children that’s doing de-institutionalization of orphans in a number of places. They’re helping the Rwandan government to close all their orphanages by 2020, and they’re ahead of schedule to do that.  It doesn’t take a wealthy country to do this; it just requires political will.

By the way, we generally don’t have orphanages any more in North America and Europe.  There’s a reason for that: we know family-based care is better.  Why is it that we’ve decided orphanages are not appropriate in our home countries, yet we’re saying, “Let’s build them in Africa because there’s a lot of orphans there who need it”?  First of all, that’s not true.  A lot of people are even saying, “Let’s get rid of this word, ‘orphan,’ altogether.”  It’s stigmatizing.  Kids don’t want to be called that.  And it’s often a misnomer.  It’s not that a child without one parent has no family and needs to be in an orphanage.  All the kids I worked with for this book—some 40 kids—lived with extended family in their community.  So I didn’t really have any association with any child care institution until the end, when I heard there’s also these baby homes, so I thought maybe I should go visit them.  That’s what got me down this rabbit hole: the cultural politics and political economy of orphanages on a broader, global scale.

“All the kids I worked with for this book—some 40 kids—lived with extended family in their community.”

 

AG: Really, the concept of “orphans” is Eurocentric insofar as it privileges two opposite-sex, biological parents.  And, in effect, it implicitly claims that once you lose both of those, you’ve lost everything.  In so-called “extended family” communities—which we see all over Africa—the concept of “orphanhood” in a sense is superfluous.

KC: Right.  It doesn’t exist—not in that form.

 

AG: Because you’ve always got other people.  In the local language, many of those other people are called “little mother” or “little father,” or “big mother” or “big father.”

KC: Right.  Or they just don’t have a word that means “orphan.”  They say, “Well, we might say enfunzi”—and they would whisper the word.  Because they don’t want a kid to hear that.

 

AG: They know it’s stigmatizing.

KC: Yeah, they know the children would feel bad to be called that.  Because it doesn’t mean the same thing that “orphan” does; it means you’ve not only lost your mother and father, but you’ve lost your “little mothers” and “little fathers”—your aunties and uncles, and your grandparents—and have basically been cast out and abandoned and have nobody.  So it’s not the same concept.

At the same time, one of the things I noted is that, when you have humanitarian assistance coming, specifically, for orphans—essentially, targeting them—these same people who acknowledge, “I wouldn’t call a child an ‘orphan’ to his face, it would be insulting, and they’d feel very bad”—these same people will say, in English, “Here are my orphans.”  And they’ll push forward “their orphans” and say the word in English and continue, ”I hear you have resources that might help me educate and feed these kids.”

Elderly Guardian w Children in Her Care An elderly guardian (right) with some of the children in her care, 2017

(photo by Kristen Cheney)

 

The unintended implication of targeting orphans in the humanitarian response is one of the things I discuss in the book.  At first, they were targeting orphans, but then they would find quickly that the status of orphans would rise higher in an extended family when orphans were targeted by humanitarian agencies.  But there’s also resentment in the family, because some kids might be going to school because sponsorship was available for “orphans” in the house.  The biological children in the same household would say, “Mommy, Daddy, why can’t I go to school?”  The parents would respond, “Because you’re not an orphan.”

It got to the point where someone from UNICEF told me, “We’d have an event where we’d distribute books and pens to orphans, and we’d hear other children saying, ‘I wish my parents were dead so I could get schoolbooks.’”  The UNICEF staff thought, “What are we doing when we have kids saying, ‘If my parents were dead, I’d get to go to school’?”

Schoolchildren in Uganda

 

Schoolchildren in Uganda, 2013 (photo by Kristen Cheney)

 

AG: It pays to be an orphan.

KC: Literally.  Or in other instances, a child soldier.  These sorts of targeting and labeling actually make people take on a role and can actually inscribe trauma where it didn’t exist.  If you’re not traumatized, but you understand the Western assumption, “You must be traumatized by being an orphan, or a child soldier,” or what have you, you figure out that if that’s the way to entitlement, then you really need to adopt that role.

And it can end up that if you really adopt that role, you can actually internalize that trauma and become vulnerable.

 

AG: There are so many unintended consequences of labeling.  And this label that you’re applying so provocatively, the “orphan industrial complex”—I guess, borrowing it from Eisenhower’s “military-industrial complex,” and then the second-generation term of the “prison-industrial complex”—that’s a really powerful concept.  I don’t think it’s yet been over-used, despite being adopted by folks critical of the prison system.  Do you find that your version of the phrase arouses interest, or just offense?

KC:  I’ve gotten good feedback.  I’m talking to those who are potentially participating in “orphan tourism”—college students, even high school students, from the global North.  So far, I’ve had pretty good reception to the term.  It is provocative.  But I do get people listening.  The way I lay it out, they start to see the bigger picture of how it works.  At first, they may come into it skeptically, saying, “What’s wrong with wanting to help?”  It’s difficult to be the killjoy who says, “This is what’s wrong with helping in certain ways,” if those ways really are destructive.  But I do say, “Here are things you can do that would be really helpful.  For example, helping keep children in families, and lobbying governments not to send them to orphanages.”

As I was saying about Rwanda, and Hope and Homes for Children, we went to DFID—the Department for International Development in London, which is like their USAID.  They handle all the development funds for the UK government.  We talked to them about divesting from orphanages and other organizations that support the institutionalization of children.  We were talking to them about this as experts.

And they were interested.  Usually, these people flit in and out of meetings, but they stayed for a good hour-and-a-half.  What really helped is that I had a former student who grew up in an orphanage in Kenya and talked about things they’d never thought about—including his loss of identity, as a child who grew up in an orphanage.  He ended up in an orphanage because his mother died in an accident.  The orphanage never made any effort to find his family.  When he was older, he wanted to see his file and try to trace his family—but he found out the orphanage staff had changed his name.  From the time he was four or five, he was called something else.

 

AG: So many layers of emotional theft. . .

KC: And he talked about how, when volunteers came to visit, they’d only pay attention and play with the cute, little ones.  It caused resentment among the other kids.  But once you’re not cute or little, you don’t get much attention from these volunteers.  Sometimes the staff would hide away the other children and only parade the disabled children, because there was a donor who was particularly interested in helping disabled children.

 “Once you’re not cute or little, you don’t get much attention from the . . . volunteers. “

 

AG: So it also pays to be disabled.

KC: There were all these ways they hadn’t thought about these issues.  I think that really moved them to have someone talk about that personal experience, and how identity gets erased. Being labelled an “orphan” has these lifelong effects.  Now he’s in his 30s, but he’s still saying, “This is the long-lasting effect of having gone through this.”

 

AG: I think your book is going to forge such a different conversation among so many kinds of people who I hope will read it.

KC: That’s what I’m hoping.  And also by being provocative about the “orphan industrial complex”—which, drawing on the “military industrial complex,” which deals with the politics of fear—but this is the politics of hope and love—and this idea of the “need to help,” as Liisa Malkki talks about, and trying to unpack that idea and be self-critical about it, and show how that has unintended consequences.  I do think people are listening to this message, and I hope they will change that discourse.

Africa, Africanist scholarship, Anthropology, Author interviews, Childhood, Community, Cultural Anthropology, Current Issues, East Africa, Education, Ethnography, HIV/AIDS, Intercultural communication, Labeling theory, medical anthropology, Orphanages, Orphans, Politics of representation, Research as advocacy, Research methods, schooling, Social activism, Social justice, Stigma, Voluntourism Read more

Do All African Immigrants Arrive Sick, Desperate, and Empty-Handed on the Shores of Europe? Ask Pamela Feldman-Savelsberg!

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The lives, status, and image of immigrants may constitute the single-most urgent human issue of our time.  In an arresting and captivating new study of Cameroonian mothers now living in Berlin, Pamela Feldman-Savelsberg challenges just about everything we thought we knew about immigrants.  Living as migrants in a nation infamous for its twentieth-century genocides against “others,” these educated, often middle-class women demonstrate over and over again the common impulses that define our shared humanity.

Mothers on the Move: Reproducing Belonging between Africa and Europe was recently published by the University of Chicago Press (2016).

Mothers on the Move-Front Cover

 

Daniel J. Smith calls it

“a wonderful book full of rich and compelling ethnographic cases.”

And Cati Coe calls it

“[a] sensitive, well-grounded, and beautifully written study of the
dilemmas immigrant mothers face when they migrate.”

You can find a Table of Contents here.

Read a free preview from the Introduction here.

The publisher offers complementary desk copies and exam copies to instructors here.

From the website of Carleton College (where she is the Broom Professor of Social Demography and Anthropology, and Director of Africana Studies), you can find Pamela Feldman-Savelsberg’s institutional home page here.

I recently interviewed Pamela Feldman-Savelsberg online about her new book.  Here’s what she had to say (AG = Alma Gottlieb; PFS = Pamela Feldman-Savelsberg):

Pamela Feldman-Savelsberg, Cameroon Cloth Dress, 12-6-14 cropped 2

Photo by Alma Gottlieb

 

Interview with Pamela Feldman-Savelsberg

AG: Your early research focused on the lives of women in Cameroon.  This book focuses on women who’ve left Cameroon to re-start their lives in Berlin.  What inspired you–both to switch fieldsites to a new continent, and to write a book on a new subject?

PFS: Each research project has opened up new questions and curiosities. Following these leads has led me to new fieldsites within Cameroon, and then within Europe. Along the way, I am not only following up on questions raised by prior research projects, but I’m also following people from the same ethnic group and region—sometimes even the same people, or their friends and children—from the countryside to the city, and on to Berlin or Paris.

And I’ve always been interested in women’s lives, in reproduction and family-making, and in tensions between belonging and marginalization. Thus, even though I’ve switched fieldsites, there’s a lot of continuity in my work.  The transnational migration aspect is new, but otherwise this book is not about an entirely new subject.

Even my next planned research project—about ways in which the contexts of reception matter for Cameroonians’ changing notions of transnational family obligations—continues along these lines, while bringing me to new sites (Paris, Cape Town).

 

AG: That should be a wonderful new project.

Meanwhile, Western media images of migrants and refugees tend to focus on the poorest of the poor—those in desperate conditions, in need of serious outlays of both aid and

African Refugee in Over-crowded Boat in Mediterranean

sympathy.  The West African migrants you profile are mostly highly educated, and at least middle-class.  Did you choose to focus on this group of semi-invisible migrants to challenge stereotypes?  What lessons can they teach Western readers?

PFS: Yes, I do aim to challenge stereotypes. I tell one among many possible stories about African migration and family-making in Europe. Other important stories have been told about migration and the search for well-being. I fear that some of these narratives end up reinforcing stereotypes of “the African migrant” as illegal(ized), impoverished, and in need of help.

In dialogue with my Cameroonian interlocutors and colleagues, I became aware of the pain caused by the repetition of a one-sided story of abjection. Stereotypes hurt.  However well-meaning, fundraising campaigns portraying poor, helpless African women and children belie the energy, intelligence, and educational resources of Cameroonian immigrant women. Without sugarcoating the hardships of migration, it’s important to let readers know that the story of abjection does not fit the data for Cameroonian immigrants to Berlin.

There are enormous distinctions in women’s lives depending not only on class background and class attainment, but also immigration status upon entering the new country, as well as the ability (or lack thereof) to maintain or obtain regularized immigration status. These critical distinctions often lead to vastly differing reproductive strategies, which in turn are linked to different ways that women seek a sense of belonging in multiple communities.

As anthropologists we look for both patterns and particularities. The former are important for telling a coherent, social-scientific story; the multiple stories of particular individuals’ lives are important to work against typification, which is by definition reductionist.

 

AG: Your book details examples of daily racism that Cameroonian immigrants experience in Berlin . . . yet, new Cameroonian migrants continue arriving.  In the wake of Germany’s role in WWII aiming to annihilate Jews, Roma, gays, and other groups of people that white Germans dubbed “Others,” how do you explain the decisions of these African elites to emigrate, of all places, to Germany?

PFS: There are many reasons that Cameroonian migrants—and as we know from the news, many, many others—choose to emigrate to Germany.  Economics is primary—because of the country’s strong economy and job opportunities.  Especially important to upwardly-mobile Cameroonians is Germany’s almost-free university education. And, interestingly, many Cameroonians appreciate the fact that it is not France. Cameroonian migrants in both Germany and France—and, as I learned this summer, those who remain home in Cameroon—perceive that immigration bureaucracy works more reliably and predictably in Germany than it does in France. Even if the UN, in its Decade for People of African Descent, finds significant structural racism in Germany, native-born Germans hold a variety of political and ideological positions. Thus, despite the catastrophic history of racism in their country, some Germans are more aware of inherent racism, and eager to discuss it, than are their counterparts in countries with less tainted histories. And, for all its faults (past and present), Germany is certainly more welcoming to refugees than is the U.S. in the current Trump era.

Still, the common question posed often by Germans to immigrants in daily life, “Where do you come from?” haunts Cameroonian parents and their children in Germany, as does the general image of “Africa” that is portrayed in mass media. One Cameroonian mother told me a poignant story about her seven-year-old son’s visit to Cameroon.  “This isn’t Africa, mom,” he exclaimed. There were no lions or giraffes, not even a little monkey in the big port city of Douala. Instead, while visiting his urban cousins, he experienced air-conditioned office buildings with elevators, manicured gardens, and schoolchildren in neatly pressed uniforms. None of this fit with the image of game parks and starving, half-naked children that the boy had learned about from television.

 

AG: Wow, what a moving (and disturbing) story.  It reminds me of all the mini-stories you write about the women whose lives you’ve followed in Berlin.  These women will feel very much like real people to a reader–individuals with their own idiosyncratic biographies and challenges, rather than what Renato Rosaldo might call the dreaded Group Noun (which, in this case, would be a single kind of person we could categorize as “Cameroonian women migrants”).  Why did you decide to feature a number of individual women, and how did you decide on these particular women to feature?

PFS: In this book I aim to portray the voices of individual women, each with her own concerns, challenges, resources, and desires. I mentioned earlier that I want to work against stereotypes and typification. This doesn’t mean that I don’t look for patterns in Cameroonian migrant women’s lives. Of course I do! Migrant women share predicaments of belonging, reproduction, and connection that are created and/or exacerbated by migration. But, shaped by their diverse biographies and circumstances, each woman manages these predicaments in her own way. I decided to feature particular women because they illustrated the diversity of women’s experiences and strategies.

When women told me about their lives, I was just fascinated by how their individual characters came through. I think of Maria telling me her love story—starting with her surprise meeting with a childhood sweetheart in Berlin—while showing me her family photo album. Or of Mrs. Black’s anguish that her white German husband just couldn’t or wouldn’t understand how important it was to her to help her extended family with gifts of cash.

I’d like to add something else about stories. Cameroonian migrant mothers share stories, or anecdotes from their lives, with one another. This is just a normal part of socializing. My book shows how, through stories, individual experiences are communicated and become crystallized into collectively held orientations toward the world, toward a new context.

 

AG: One of the key concepts you deploy in the book is the notion of “affective circuits.”  Can you speak about how you seized on that metaphor from electrical engineering to speak to the issues concerning migration that you are tackling?

PFS: I didn’t invent the term. I got the idea from our fellow anthropologists, Jennifer Cole and Christian Groes, who had invited me to contribute to an edited volume on affective circuits. I loved the layers of metaphors—gesturing simultaneously toward research on migration circuits and toward electrical engineering—so I took the idea and ran with it, developing the notion further. So often in studies of social capital, researchers write as if economic and informational flows along network ties are constant. But the network ties of the women I studied were neither constant nor additive. Women dropped some relationships, gained others, and then renewed old ties, depending upon how their circumstances and their feelings changed. Neither words (whether loving or nagging) nor money nor presents flowed continuously along women’s social connections; the flows stop and start and must be managed. And this careful management that women do is all bound up in the feelings they have toward their families, their fellow migrants, and the German bureaucrats they meet.

 

AG: Indeed.  Moreover, in Berlin, the children of the migrants you’ve followed are growing up in very different circumstances from the childhoods of their parents.  You’ve highlighted the term “Belonging” in your subtitle.  Can you talk about the different issues that the two generations experience as black migrants in a predominantly white nation?

PFS:  What an interesting question, with many layers! Some aspects of belonging are not questioned in Cameroon, but are brought to consciousness in Germany. One difference is that parents, growing up in Cameroon, largely didn’t have to worry about being black. They didn’t grow up as a “minority”—but their children do. On the other hand, the children of migrants grow up fluent in German, and they get early practice in code-switching between forms of behavior deemed appropriate in “German” vs. “Cameroonian” settings. Language learning and cultural adaptation are more challenging and self-conscious for their parents.

Another difference is that migrants who arrived in Germany as adults had earlier experienced challenges of belonging in Cameroon. It may seem surprising that individuals have a hard time belonging in their country of origin, but the legacies of Cameroon’s complex colonial history (which included three different colonial powers—Germany, France, and England) mean that people of certain ethnic groups and regions are disadvantaged on the national scene. These groups—for example, the Bamiléké and English-speaking Cameroonians—make up a large proportion of the Cameroonian diaspora. Their children, by contrast, grow up in Germany with a different view of their homeland—a place of origin, a place to visit, a place where Grandma and Grandpa live.

Still another difference in migrants’ experiences concerns recent historical change in Germany.  Earlier migrants faced many more challenges than do more recent migrants, because there are now settled migrants and migrant organizations that can ease newcomers’ transition to life in Germany.

 

AG: In the US, we now have a president who campaigned on a platform of drastically restricting immigration, and many of his supporters easily denounce whole groups of immigrants.  Alongside health care reform, restricting immigration (including refugee applications) has been one of Trump’s major agendas.  What do the experiences of Cameroonian immigrant women in Germany have to teach us in the US?

PFS: Immigrants can bring a lot to our country. Overall, immigrants are more law-abiding than native-born Americans, and in terms of college and post-graduate degrees, they are better educated. Immigrants tend to be ambitious, making many personal sacrifices for the well-being of their children and families. We have a lot to learn from them when we consider “family values,” and perhaps even reconsider what family can mean. Providing chances and being welcoming allows these immigrants to contribute to society.

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An Anthropologist at the Women’s March on Washington, Part 1: Finding Communitas, Feminist Style

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Mass of Demonstrators in Front of Capitol 1, cropped
(photo by Alma Gottlieb)
The doors of our metro car opened and closed, opened and closed with increasingly alarming dysfunction.  On any other day, the many more dozens of people jammed into our subway car than (for safety reasons) should have occupied our tight, air-deprived space would have panicked–jostled, elbowed, and accused one another.  Instead, taking the occasion as an opportunity to befriend new neighbors, we asked from where and how far our companions had traveled, asked where they were staying, asked if the growing-short-of-breath needed water.  In other words, we bonded.
Anthropologists have a name for that feeling of spontaneous community that developed in an unlikely place: we call it, “communitas.”  Coined by the great Victor Turner (one of my long-ago mentors), the term originally referred to feelings of solidarity forged in African initiation rituals.  But anthropologists now apply the word to all sorts of places beyond rain forest groves.  Two days ago, an urban subway offered my first sighting of communitas in Washington, D.C.–but certainly not my last.  On Jan. 21, 2017, feminism and anthropology converged, as women around the country–and around the world–forged a sense of communitas that, unlike many temporary feelings of communitas, may well have lasting effects beyond the day’s euphoria.
Indeed, after it was over, yesterday’s march in the nation’s capital felt, if anything, infinitely grander and more important when we learned of the 600 or so sister marches around the world attracting some 2 million protestors, begun on Facebook and coordinated by the miracle of social media.
*
I’m old enough to have intense teenage memories of participating in the huge marches on Washington of the 1960s, supporting civil rights and protesting the Vietnam War.  But my anthropologist friend, Linda Seligmann, and I were accompanied to yesterday’s march by three young women (aged 17 to 21 years old) who had never participated in such a momentous event.
A, H, Mina, Charlotte on Subway
(photo by Linda Seligmann)
I watched their wide-eyed wonder with delight as some 500,000+ strangers, mostly women, found a new pink-knit-capped sisterhood.
Mass of Demonstrators, Pink Hats, cropped more
(photo by Alma Gottlieb)
My day’s companions had their own somatic challenges.  One became dizzy and nearly fainted in the overcrowded, under-oxygenated metro car we occupied for nearly two hours; another exercised all her willpower to control her bladder, when toilet facilities proved elusive during six hours of enforced standing.  And yet, they never complained, never begged for an exit strategy.  Instead, they felt that strong pull of communitas.
I, myself, felt the tug of an old back injury asserting itself as those six hours of standing activated muscular fatigue.  And yet, communitas asserted a stronger pull.
After three hours of listening to inspirational speeches, many in the crowd became restless. “Start the march!  Start the march!” some began chanting.  And, indeed, some began marching (or, truth to tell, shuffling, amidst the thousands of protesters barely able to move), while others remained at the rally, to listen to yet more speakers.  Yet even that splintering of attention didn’t fracture our sense of common purpose.  Among those who stayed behind and those who forged on, communitas asserted a stronger pull.
Some protest signs and speeches signaled disturbing acts of police abuse across our troubled land.  And yet, even when faced with police officers and security guards trying to direct our unruly numbers, communitas won out, as protesters and cops responded with noticeable civility to one another.
The people who flocked to the nation’s capital looked more diverse than those at any march in my memory.  Judging by what I saw and heard, the event attracted white, brown and black folks; Christians, Jews, Muslims, and Hindus; straight people, gay people, drag queens, and everything-in-between; breastfeeding babies and grandmothers in wheelchairs; sighted walkers and white-caned walkers; people sporting designer clothes and others wearing hand-me-downs; groups of teachers and groups of students; executives and labor union members; English-speaking and Spanish-speaking youth.
Latina Girls with Posters
(photo by Alma Gottlieb)
And yet, despite this extraordinarily diverse concatenation of humanity, we forged communitas.
Muslim Woman Holding Poster (LS Photo) cropped
(photo by Linda Seligmann)
Or perhaps I should say, because of that extraordinarily diverse concatenation of humanity, we forged communitas.
Poster-We Are All Immigrants (LS Photo)
(photo by Linda Seligmann)
*
I don’t mean to paint an overly Pollyana-ish portrait of an admittedly extraordinary day.  The challenges to maintaining momentum and organizing such a diverse constituency into a viable political movement are far from trivial.
But in the right circumstances, communitas can also cast a long shadow that can even produce some staying power.  Maybe, just maybe, it may prove powerful enough to help the organizers of these diverse groups–both those with impressive experience, and those just cutting their eye teeth on their first demonstration–mobilize the global energy, incorporating both love and anger, that asserted itself yesterday on all seven continents.
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The Story behind “A World of Babies”

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Interested in learning some behind-the-scenes stories about how “A World of Babies” came into existence?

Check out a new interview with my co-editor, Judy DeLoache, and me in a newsletter published this month by the Jacobs Foundation, a private organization (based in Zurich, Switzerland) dedicated to improving the lives of the world’s youth.

jacobs-fdtn-newsletter-screenshot

Here’s a sneak preview:

Gottlieb: “For urban populations in Europe and the US it always sounds amazing to imagine what it would be like if we had a more collectively oriented child-rearing style. But the truth is it doesn’t easily fit most of our lifestyles. When both our children were young, my husband and I were living a thousand miles away from our family. Unlike Beng mothers, I didn’t have nieces, sisters, aunts, and cousins to help carry our children. It would be wonderful if we had a more communal approach to child-rearing, but in practical terms, it’s hard for those of us who arrange our lives in nuclear families. Implementing a different baby-carrying regimen really means implementing a different family structure and residential pattern, and creating a sense of community such that a much larger group of people than a mother sees itself as responsible for the well-being of each child.”

Check out the full interview here:

“There is not one right way to raise children, there are many ways”

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