Artigo Original Anais do IHMT Stories from the past and everyday experiences of malaria: Portugal, 1930-1960* Histórias do passado e experiências quotidianas da malária: Portugal 1930-1960* Mónica Saavedra CRIA - Centro em Rede de Investigação em Antropologia, ISCTE-IUL Resumo Abstract Este artigo é uma breve história sobre a malária em Portugal entre 1930 This article is a brief history of malaria in Portugal, from 1930 up e 1960. Centra-se nas memórias e narrativas das experiências individuais to 1960. It centres on the memories and discourses of former rural de “ter malária”, de antigos trabalhadores rurais. Pretende tomar estas workers about their personal experiences of “having malaria”. It takes memórias como o ponto de partida metodológico, que revela a malária these memories as the methodological standpoint to analyse the com- como uma doença complexa, de amplas conexões sociais, ecológicas, eco- plexity of malaria, a disease with broad social, ecological, economic nómicas e políticas, que alberga diversos significados e definições. Neste and political dimensions. The article also highlights the multiplicity artigo procura-se também recuperar a dimensão física da doença, confor- of meanings and definitions it comprises and retrieves the physical me rememorada pelos antigos trabalhadores rurais; propõe, assim, uma dimension of the disease, as remembered by former rural workers. It abordagem histórica e antropológica à malária, que procura dar conta da thus proposes an historical and anthropological approach to malaria sua complexidade. that endeavours to grasp its complexity. Palavras Chave: Key Words: Malária, memória, história, antropologia, Portugal. Malaria, memory, history, anthropology, Portugal. * This paper is a shorter version of some parts of the book A Malária em Portugal: Histórias e Memórias (Lisbon: Imprensa de Ciências Sociais, 2014). Parts of this paper have also been published in the article “Malária, mosquitos e ruralidade no Portugal do século XX”, Etnográfica, 2013, 17, 1: 51-76 (DOI: 10.4000/etnografica.2545). An Inst Hig Med Trop 2017; 16: 51-59 51 Artigo Original This is a short story about malaria in Portugal; the story source among others for writing one of the many pos- of a time when malaria was not just a disease of the sible histories of malaria in Portugal also means going tropics but also a domestic ailment that hassled rural beyond concerns about objectivity and truth. Certainly populations at intervals. I intend to consider malaria I mean to be as accurate as an anthropologist/historian as perceived and defined by former rural workers as should be in my account and analysis of the sources that a methodological standpoint that reveals this disease I have deliberately chosen, actually accessed or acciden- as a broad social, ecological, economic and political tally found. But through the research process I relished event with multiple definitions (Saavedra 2014). This is the contradictions, misunderstandings and intersect- where a biosocial and syndemic perspective (Hanna and ing meanings, taking this as fundamental to a broader Kleinman 2013; Singer 2009), as proposed by medi- understanding of malaria’s complexities patent in the cal anthropology, proves appropriate. Although each of distance between scientific knowledge, sanitary regula- these approaches has its specificities, both consider dis- tion, institutional norms and the everyday practice of ease causation as the result of the interaction between malaria control and treatment on the ground. political, social, biological and environmental factors and their historical framework. Moreover, both take the impact of these interactions on people’s lives as the Malaria memories and rice fields centre of their action-oriented analysis. Documents in archives and libraries in Lisbon men- By privileging former rural workers’ memories I fol- tion rural workers, especially migrant groups, mainly lowed medical accounts of malaria as a rural disease. I in- as subjects of medical research and action (Cambournac terviewed fifty men and women from 65 to 90 years old, 1938, Hill 1938, Landeiro and Cambournac n.d.). So- almost all of them former rural workers. Also according cial factors as disease causation were discussed among to the medical and official sources, I looked for malaria Portuguese doctors as fundamental parts of preventive memories in Alcácer do Sal, Águas de Moura, Azambuja medicine and of the State’s social and medical services and Benavente. These villages and small towns, as well as (Faria 1934). But such factors were not considered in the surrounding areas, had been medically classified as their deepest structural causes. A few doctors did write malarious; specially following a 1933 survey carried out accounts of malaria describing the living conditions of a by two Portuguese doctors (Fausto Landeiro and Fran- great portion of the rural population, drawing attention cisco Cambournac), under the sponsorship and supervi- to their poverty and how all these compromised any at- sion of the International Health Division of the Rockefel- tempt at eliminating the disease (Ramos 1944). However, ler Foundation (Landeiro and Cambournac n.d.). This in a country where censorship controlled every printed brings us to a medical geography of malaria in Portugal text, not much could be said lest too much was said. evincing its ecological aspects. By recovering personal memories of people who had “Intermittent fevers” in Portugal, as in the rest of the malaria, I intend to retrieve the physical dimension of world where European science gained ground, had long the disease, the local appropriation of medical models been medically described and popularly perceived as and resources, and the coexistence of different ways the result of bad airs emanating from swampy lands and of perceiving the disease (Saavedra 2014). Narratives putrefactive vegetable matter. Thus, since the increase about experiencing malaria reveal its broader ecology, of rice cultivation in flooded fields during the 18th cen- combining natural environment, personal, social, cul- tury, rice fields became connected to malaria: tural, political, economic and historic factors. Thus, malaria memories add to the medical narratives about We have widely made known the effects of the stagnant this disease, meeting contemporary approaches to waters and floods, but those that remain on the fields health issues in the fields of history of medicine, medi- after rice cultivation are the most pernicious. It is known cal anthropology and in critical epidemiology (Singer that, to fructify, that plant needs to be covered in water 2009, Breilh 2008, Rosenberg 1992) that emphasise and have the fields where the seeds lay flooded. And if the multiple dimensions of disease. On the other hand, landowners do not drain these waters as soon as sowing is personal narratives about ‘having malaria’ may also in- over through channels, drawbridges and dykes then those spire a reflection about the estrangement between the waters remain exposed to summer heat during the months 21st century’s scientific agendas for malaria research, of August and September; the air becomes infected and control and prevention and the compound everyday ex- people pay the price with every sort of fevers that finish perience of living with and managing this disease. Thus, by death or illness that lasts a life long (Sanches 1757, history meets the present and calls attention to some- 84, 85). times overlooked perspectives on health and illness. Taking personal memories of malaria experiences as a Swampy lands and decaying vegetable matter, high tem- 52 Anais do IHMT peratures and soil emanations were widely perceived by in the world; it is still among them that it causes the Western medicine as sources of “intermittent fevers”, greater number of deaths. Until the 1970s Portugal had as well in the “Tropics” as in Europe. The change from high infant mortality rates (77,5 per thousand in 1960, a malaria causation model based on “miasmatic” or “tel- 55,5 per thousand in 1970),1 which were seen by Por- luric” elements to a parasitological model based on a tuguese doctors as a disgrace to the national reputation specific cause – a parasite transmitted to man through and a pressing sign of much needed improvement in the bite of an Anopheles mosquito – did not acquit flood- health policies. But malaria was not one of the main ed or swampy lands; consequently it did not acquit causes of children´s deaths. rice fields. As mosquitoes’ breeding sites, these lands However, sources suggest that some Portuguese doc- kept their insalubrious reputation. Until its disappear- tors may have seen this disease as a gateway into the ance from Portugal, around 1960, malaria had always enhancement of state supported health services, by been related to rice cultivation with rare exceptions. applying for international technical and financial aid From the 1930s, and particularly after the 1933 sur- (Saavedra 2014). The Malaria Committee of the League vey, rice fields became the scientifically legitimized axis of Nations Health Organisation had drawn up a set of of malaria research and control actions in Portugal in recommendations regarding malaria control, in the an effort undertaken by some doctors to follow inter- late 1920s. These comprehended research, prevention national health trends, and strategies professed by the and treatment (League of Nations - Health Organisa- League of Nations Health Organisation and its Malaria tion 1927). Also, in 1931 the Health