Cholera at the Border

CHOLERA AT THE BORDER: DISEASE NARRATIVES AND HUMANITARIANISM ON HISPANIOLA A MASTER’S THESIS SUBMITTED TO THE DEPARTMENT OF ANTHROPOLOGY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS OF THE SCHOOL OF LIBERAL ARTS OF TULANE UNIVERSITY FOR THE DEGREE OF MASTER OF ARTS BY _________________________________________ Kyrstin Mallon Andrews APPROVED: _________________________________________ Adeline Masquelier, PhD, Director _________________________________________ João Goncalves, PhD _________________________________________ Arachu Castro, PhD, MPH iii ii Acknowledgements This thesis has been, above all, a great pleasure to write. A huge part of the joy in writing comes from the people who have contributed to that process, so it is my pleasure to extend thanks to those who have made this work possible. This project would not have been imaginable without the support of the Department of Anthropology at Tulane University and the intellectual and personal guidance of their faculty and staff. The Stone Center and the Tinker Foundation also have been fundamental in supporting the field research and development of this project. I owe insights, introductions and inspiration to the wonderful people at Solidaridad Fronteriza, your support and trust has kept this project alive. The members of my committee have graciously offered a copious amount of time to advising my work in this process. Adeline Masquelier has been an incredible mentor, offering both encouragement and inspiration through her dedication to students and the incredible creative energy with which she pursues her own work. This project grew out of an independent study with Adeline that inspired me to rethink ideas of intervention and borders in medical humanitarianism. João Goncalves jumped headfirst and at short notice into my thesis committee, engaging wholeheartedly with my drafts and guiding me towards a finished product. As an aspiring medical anthropologist, I am ecstatic to have had the insight and expertise of Arachu Castro, whose contributions to this project will surpass its written form. iii I am beyond grateful to my father, for spotting me as I attempt to balance the line between the professional and the poetic, to my mother, for steering me towards elegance and strength, and to Kasey, for letting me distract you when I needed to be distracted and for calling me out in my moments of insanity. This thesis is dedicated to the border and the people who live and love it. You are all heroes to me. iv List of Figures Figure 1: Map of first cases of cholera in Haiti, from UCLA Department of Epidemiology Figure 2: Dominican Red Cross poster showing symptoms and ways to avoid cholera. Picture taken by author in Pedernales, Dominican Republic. Figure 3: Map of cholera aid to Haiti, from USAID Figure 4: Map of cholera cases and populations Figure 5: Map of cholera outbreak, from Center for Disease Control Figure 6: Cholera attack rate for Dominican Republic, from Ministry of Public Health, Dominican Republic v Table of Contents Acknowledgements …………………………………………………………….. ii List of Figures …………………………………………………………………. iv Table of Contents …………………………………………………………………. v Introduction……………………………………………………………………… 1 Chapter One: The Systematics of Humanitarian Aid …………..……………….. 19 Chapter Two: How Cholera Came to Hispaniola ……………………………… 29 Chapter Three: Border Pathologies …………………….……………………….. 43 Conclusion …………………………………………………………….…………. 56 Bibliography ………………………………………………………………………. 59 1 INTRODUCTION In October of 2010, on the only Caribbean island shared by two independent states, cholera broke out in rural Haiti. Nine months earlier, on January 12, a massive earthquake had leveled the Haitian capital, deteriorating infrastructure in the western hemisphere’s poorest nation. The deadly epidemic that followed exacerbated conditions in a post-disaster environment, where international organizations had responded to the earthquake with a flood of humanitarian relief. While Haiti’s international reputation hinges upon its poverty, a reputation supported by the mass of aid sent to alleviate suffering there, on the eastern wing of the same island (Hispaniola), the Dominican Republic enjoys relative stability and the reputation of a tropical tourist destination. With the cholera outbreak in Haiti, the Dominican state reacted immediately by reinforcing the 275 km long land border against this pathogen. Cholera spread quickly through Haiti, arriving at the border in early November where public health and military officials on the Dominican side restricted Haitian immigration. Media accounts narrated the battle against the spread of cholera in Dajabón, the northern region’s largest border town. When I arrived in Dajabón two and a half years after the appearance of cholera, very few Dominicans were willing or able to talk about the outbreak. First hand accounts of the disease were hard to come by, and I was beginning to feel that my research on cholera in the borderlands was largely irrelevant to the lives of ordinary Dominicans. During a conversation with a Dominican man who worked for a Jesuit NGO, I pointed to the mobile hand washing stations that had been set 2 up along the border, requiring Haitians entering the Dominican Republic to wash their hands in chlorinated water. Didn’t this impromptu public health infrastructure and the media attention it garnered reflect the threat of contagion? My interlocutor redirected my inquiry: “They put the sinks there for the press. There was never much cholera up here.” By suggesting that hand-washing stations at the border served a purpose other than sanitary regulation, this man’s comment jolted my ethnographic perspective and revealed what border residents knew well: state reactions to cholera on the border set the stage for a media narrative that strategically overstated the threat of disease. This man was one of many border residents who understood both the sinks and the media coverage as a part of an orchestrated effort to exaggerate the health crisis the Dominican Republic was facing at the border. What border residents seemed to agree on was the unreliability of media narratives about the region. As I asked about other key events that I had heard about through the filter of Dominican and international newspapers alike, many of my informants scoffed at the inaccuracies of reporters. Disagreements involving Haitians and the Dominican military or migration officials, they claimed, suffered severely from media dramatization. International media coverage of cholera in Haiti depicted a vivid hygienic chaos, a landscape ravaged first by the earthquake and then again by a deadly epidemic. A reporter from Al Jazeera described the confusion as hospitals attempted to treat earthquake victims alongside cholera victims, calling the scene “absolutely horrific” and “total chaos” (2010). Dominican media and state narratives similarly reiterated this mayhem, but they gave special attention to the militarization of the border and the restrictions placed on Haitian immigration, tactics understood as attempts to keep the disease out of the Spanish 3 speaking part of the island. The importance of closing the border was reiterated in the press, and in reference to crackdowns on border control, the Dominican director of customs claimed, “It is necessary to take extreme measures, it is preferable to be mistaken by excess than by omission” (Listín Diario 2010, my translation). Based on the relative absence of popular memory in the border region about the fairly recent outbreak of cholera, how do national discourses reconcile with border realities? Vivid depictions of a struggle against the onslaught of Haitians fleeing the disease (and potentially carrying it), emphasized by newspaper images of military blockades at the border,seemed to fall flat as I attempted to line them up with the experiences of border residents. In this thesis, I map the intersections and overlap between the cholera outbreak and humanitarian reason on Hispaniola. I first trace the logic of humanitarian action that has contributed to the current condition of Haiti, looking specifically to how the systematics of aid magnify suffering within certain national boundaries. As the source of suffering, a deadly bacterium, traverses national boundaries, state reactions playing out on both a national and international stage reveal how longstanding anxieties articulate with this newer logic of humanitarianism. I argue that the humanitarian regime and its response to crisis in Haiti constructed a discourse that first fit into Dominican narratives of difference based on identity, and that secondly blurs the public health crisis experienced in the Dominican Republic. While relations between Haitians and Dominicans have historically been mediated by regional political and economic relationships, humanitarian aid in Haiti has added another dimension to the way the Dominican state conceives and performs its identity at the border. 4 For the purpose of my analysis, I use multiple news reports from international and Dominican sources in conjuncture with statistics and reports from regional and global health organizations to address the way cholera was reported and recorded following the outbreak. In the process of researching media responses to cholera, the chaotic state of hygiene and disease in Haiti was one thread that emerged predominantly in international media sources. On the other hand, Dominican media reflected a more conservative style of reporting cholera cases within Dominican territory, emphasizing instead

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