Health Travels Cuban Health(Care) on and Off the Island Perspectives in Medical Humanities
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Health Travels Cuban Health(care) On and Off the Island Perspectives in Medical Humanities Perspectives in Medical Humanities publishes scholarship produced or reviewed under the auspices of the University of California Medical Humanities Consortium, a multi-campus collaborative of faculty, students and trainees in the humanities, medi- cine, and health sciences. Our series invites scholars from the humanities and health care professions to share narratives and analysis on health, healing, and the contexts of our beliefs and practices that impact biomedical inquiry. General Editor Brian Dolan, PhD, Professor of Social Medicine and Medical Humanities, University of California, San Francisco (ucsf) Recent Titles Clowns and Jokers Can Heal Us: Comedy and Medicine By Albert Howard Carter III (Fall 2011) The Remarkables: Endocrine Abnormalities in Art By Carol Clark and Orlo Clark (Winter 2011) Health Citizenship: Essays in Social Medicine and Biomedical Politics By Dorothy Porter (Winter 2011) What to Read on Love, not Sex: Freud, Fiction, and the Articulation of Truth in Modern Psychological Science By Edison Miyawaki, MD; Foreword by Harold Bloom (Fall 2012) Patient Poets: Illness from Inside Out By Marilyn Chandler McEntyre (Spring 2013) www.UCMedicalHumanitiesPress.com [email protected] This series is made possible by the generous support of the Dean of the School of Medicine at UCSF, the Center for Humanities and Health Sciences at UCSF, and a mcrp grant from the University of California Office of the President. Health Travels Cuban Health(care) On and Off the Island Edited by Nancy J. Burke, PhD First published in 2013 University of California Medical Humanities Press in partnership with California Digital Library San Francisco - Berkeley © 2013 University of California Medical Humanities Consortium 3333 California Street, Suite 485 San Francisco, ca 94143-0850 Designed by Eduardo de Ugarte Library of Congress Control Number: 2013937068 isbn 978-0-9889865-1-0 Printed in usa Contents Acknowledgments vii Contributors viii Introduction: Cuban Health(care) and the Anthropology of Global Health Nancy J. Burke 1 Section I: History, Affect, and Materiality: Public Health Campaigns and Food Insecurity 1 The Biocommunicable State: Dengue, Media, and Indiscipline in La Habana Charles L. Briggs 23 2 Disconnecting the Mind and Essentialized Fare: Identity, Consumption, and Mental Distress in Santiago de Cuba Hanna Garth 54 3 Eating in Cuban: The Cuban Cena in Literature and Film Susannah Rodríguez Drissi 85 Section II: Social Accountability and “the Gift”: Internationalism and Cuban Medical Diplomacy 4 Fifty Years of Cuba’s Medical Diplomacy: From Idealism to Pragmatism Julie Feinsilver 105 5 Fueling la Revolución: Itinerant Physicians, Transactional Humanitarianism, and Shifting Moral Economies in Post-Soviet Cuba P. Sean Brotherton 129 6 Transformative Medical Education and the Making of New Clinical Subjectivities through Cuban-Bolivian Medical Diplomacy Alissa Bernstein 154 7 Cuban Internacionalistas, Sports, and the Health of the “Socialist Body” in Cuba and Africa Ayesha Nibbe 178 Section III: Global, Local, and Personal: Biomedical Practices and Interpretations 8 Conceiving Statistics: The Local Practice and Global Politics of Reproductive Health Care in Havana Elise Andaya 205 9 Family Medicine, “La Herencia” and Breast Cancer; Understanding the (Dis)continuities of Predictive Genetics in Cuba Sahra Gibbon 230 10 Masculinity and Sexuality in Cuba: Myths and Realities Julio César González Pagés 255 Acknowledgments his volume emerged from an October 2010 conference I organized with TRaul Fernandez, Director of the University of California (UC)-Cuba Multi-Campus Academic Initiative, in Berkeley, CA entitled “In Sickness and in Health: Encountering Wellness in Cuba and the United States.” The many hours we spent planning the conference, and subsequently discussing this volume, were unimaginable when we first came up with the idea in the café of the Habana Libre over cortados. I am indebted to Raul for his mentorship, humor, and calm presence. Special thanks go to Laura Enriquez, Lisa García-Bedolla, Kamran Nayeri, and Richard Quint for their help planning and organizing the conference. Funding to bring together U.S.- and Cuba-based scholars in the conference was provided by the UC-Cuba Multi-Campus Academic Initiative, the UCSF Global Health Sciences Health Diplomacy and Medical Education in Cuba Program, the UCSF/UCB Joint Medical Anthropology Program, the UC Institute on Global Conflict and Cooperation, the UCB Townsend Center for the Humanities, the UCB Center for Latino Policy Research, and the UCB Andrew W. Mellon Program in Latin American Sociology. A subset of the papers presented are included herein, and have been discussed and presented in annual meetings of the American Anthropological Association. Thanks to all the contributors for their collegiality, insight, originality, and commitment to critical engagement. Appreciation is owed to three anonymous reviewers who carefully read each chapter and offered wise and constructive suggestions for revision. Hannah Leslie assisted in the preparation of the manuscript. Without her help and careful eye for detail I would possibly still be checking bibliographies. Thanks also go to the series editor, Brian Dolan, for his support and guidance through this process. Special appreciation for Tony, Marina, Nibaldo, Juan Carlos, Caceres, Elba, and Javier who have taught me so much about health and care on the island, and to Niurka and Xiomara who have welcomed me into their homes and lives over the last twenty years. Finally, thanks go to the faculty and graduate students of the UC-Cuba Multi-Campus Academic Initiative whose excitement, interest, and questions in annual workshops and meetings encouraged me to continue this work. Nancy J. Burke Contributors Elise Andaya is Assistant Professor of Anthropology at the University at Albany (SUNY). She has published in journals such as Medical Anthropology Quarterly, Feminist Studies, as well as in a number of edited volumes, and is cur- rently finishing a book that examines shifts in ideologies and practices around reproduction, gender, and kinship in Havana since the fall of the socialist bloc. Alissa Bernstein is a PhD candidate in the Joint University of California, San Francisco/University of California, Berkeley Medical Anthropology Program. Her dissertation research is on the designing and circulation of new health reform policy in Bolivia. She has also conducted research in Cuba and Bolivia on medical education and medical humanitarianism. Charles L. Briggs is a Professor in the Department of Anthropology, Uni- versity of California, Berkeley and the Joint University of California, San Francisco/University of California, Berkeley Medical Anthropology Program. He has published widely in anthropology and social science journals. His books include Learning How to Ask (1986), Voices of Modernity (with Richard Bauman, 2003), and Stories in the Time of Cholera (with Clara Mantini-Briggs, 2004). P. Sean Brotherton is an Assistant Professor of Anthropology at Yale Univer- sity. His research and teaching interests are concerned with the critical study of health, medicine, the state, subjectivity, and the body, drawing upon con- temporary social theory and postcolonial studies. He conducts fieldwork in the Caribbean and Latin American, particularly Cuba and Jamaica, and is the author of Revolutionary Medicine: Health and the Body in Post-Soviet Cuba (2013). Nancy J. Burke is an Associate Professor in the Department of Anthropology, History, and Social Medicine at the University of California, San Francisco and the Joint University of California, San Francisco/University of California, Berkeley Medical Anthropology Program. Since 2009 she has served as the Director of the Health Diplomacy and Medical Education in Cuba Program in the UCSF Institute of Global Health Sciences. Her research focuses on the anthropology of cancer in the United States and chronic disease management in Cuba. Contributors ix Susannah Rodríguez Drissi is a lecturer in the Department of Comparative Literature, University of California, Los Angeles. Her dissertation research proposes an interpretive paradigm to explore the Moorish, Arab, Islamic, and Algerian presence in Cuban literature and cultural studies. She is currently completing an English translation of Cuban ethnographer Lydia Cabrera’s Porque…Cuentos negros de Cuba [Because…Afro-Cuban Tales] with critical introduction, to be published by University Press of Florida. Julie Feinsilver is a Scholar-in-Residence at the American University School of International Service’s International Development Program, and an inde- pendent consultant. She has conducted research on Cuban medical diplomacy since 1979. Her publications include Healing the Masses: Cuban Health Politics At Home and Abroad (1993) as well as numerous articles and book chapters addressing Cuba’s medical diplomacy, biotechnology development, foreign relations, non-traditional exports, and politics of health. Hanna Garth is a PhD candidate in the Department of Anthropology, Uni- versity of California, Los Angeles. She is broadly interested in studying how people use food systems. Her most recent project analyzes the ways in which the changing food rationing system in Cuba affects household and community dynamics and in turn individual subject positions. She also conducts fieldwork in Los Angeles-based food justice organizations, and has previously