(9) Colonial medicine

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International health (Greene)

efforts to improve the health of populations (development programs)

Ecological imperialism (Greene)

exchange of organisms triggered by exploration and conquest

White mans grave and what it led to (Greene)

1. link between colonial medicine & colonial conquest

2. use of the tropics - test subjects for medicinal and public health research
   The extremely high mortality rate among European colonizers, soldiers, and missionaries due to tropical diseases

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imperial hygine (Greene)

focused on the uncivilized and unclean practices of nonwhites, whose primitive state made them a menace for the civilized world

Disease jepordized

European Trade & health of soilders, settlers, workers

Tropical medicine (3 points)

global health connotates the idea of “elsewhere”
they could control the damaging effects of disease by fighting non-human vectors w/o providing services to the native population
the healthy carrier - whose hygenic practices were important to disease control & the diseased native

Christian / protestant mdeical missions

detribalization
treated them as collective instead of individuals
hoped clinics would encourage people to shake their traditional faiths

Case study: Cholera epidemic (Greene)

threat to the future of commerce
miasma theory - bad smelling air = diseases
came to define geography (wealthy people lived on the hilltop)

Rockerfeller foundation (Greene)

international health program
creation of waste-removal and clean water supplies
created a sense of stability and rational-legal authority

What does the Institutionalization of health institutions do?(Greene)

enforces that centralized processes were superior to local practices
“iron cage” - difficult to challenge institutional knowledge that society deemed as scientific
designed to address health problems of ‘backwards’ people who need a dose of modernity

colonial state institutions did what? or rather not do? (Green)

rarely extended resources so they are (colonies) are left with incomplete infrastructures

Health care in rural areas requires? (Drobac)

biological medical care with interventions against structural violence

What does Drobac argue we need to do with health care?

move away from selective primary healthcare to a rights-based, reparative delivery model

Drobac case study 1: Hati / PIH

Legacies, removing barriers, and….

legacy of displacement and debt by the french = no public funding for health and infrastructure
Removing barriers: free care + travel stipend, paid community health workers, home visits

HIV and TB spread was NOT driven by cultural superstition, but rather poverty and gender vulnerability

What was the key to successful health outcomes (Drobac)

removing structural and financial barriers

PIH health care delivery model

1. strengthening access to primary health care

2. provide free health care & edu to the pool

3. rely on community partnerships - train and pay local community health workers

4. address social and economic needs

5. work with gov’t (can provide legal right to healthcare)

6. focus on women and children

Drobac on health delivery

bottom-up approach based on historical study
address social cultural barriers to health
Haiti decolonizes from france but THEN had an export-based agric. system
community based interventions (healthcare workers at grassroots)
bundling of health care (nutrition, HIV, roads, edu

Drobac Haiti —> Rwanda

reproduced in Rwanda
not one size fits all, need to consider history and cultural context
BUT the idea of bundling healthcare with other structures can be replicated in similar situations
start with edu / institutions that support public health
need to understand history & culture to know how to properly help

3 points of global health (lecture)

1. history offers many lessons for modern global health iniatives (greene)

2. knowledge frameworks matter and is influential

3. why colonial medicine? - military health and to keep labor healthy for commodity extraction

Medicine took on a

civilizing and survival mission

Regime of justification?

Discourse

Foucat (lecture)

knowledge frameworks shape discourse and action
drives the social construction of disease and its racialization

western health interventions

coercive, top-down, western, militarized

Panama canal ideas

Americans had to keep the workforce healthy!
William Gorgas - eradicates yellow fever by aggressive pesticides
Decided this was a good model for Pan American Health Organization → WHO
Centralized health organizations created the notion that one-size fits all was better than decentralized health care

Ideas of WHO

formed as centralized, wester-expert driven approaches to tropical medicine
tensions between biomedical and biosocial approaches to health