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

______Kyrstin Mallon Andrews

APPROVED: ______Adeline Masquelier, PhD, Director

______João Goncalves, PhD

______Arachu Castro, PhD, MPH

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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.

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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.

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

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

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.

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 the maturity of the nation’s infrastructure and the quick responses to possible pathological threats.

This analysis also draws from ethnographic research in Dajabón, Dominican Republic during May and June of 2013. While at the border, I worked closely with the Dominican

Jesuit organization, Solidaridad Fronteriza, which fosters working relationships with community members, border patrol officers, international NGOs, and development organizations. Their goals are to organize in defense of the rights of vulnerable Haitians and Dominicans in the region.

My research in Dajabón was originally meant to record the effects of cholera on the daily lives of border residents, but following the interests and concerns of my informants, my ethnographic work bent towards an exploration of the multiple performances of health and nationhood at the border. While in Dajabón I conducted fifteen structured interviews in Spanish and one in English with border residents,

European Union development project managers, local human rights advocacy organizations, and NGO affiliates. I also recorded fifteen semi-structured interviews in

Spanish, many of them as follow-up conversations to structured interviews. While these interviews and observations of the border enhance the argument of this thesis, more

5 extensive field research needs to be done in order to more fully grasp how public health and security concerns complicate the way border residents relate both to themselves and to the state.

The significance of the cholera outbreak and how it resonated in the media can only be appreciated against the backdrop of the post-earthquake recovery Haiti has undergone. On January 12, 2010, a magnitude 7.0 earthquake hit Port-au-Prince, Haiti’s densely packed and precariously structured capital. The disaster killed hundreds of thousands of people, trapping thousands more, and destroying a great part of the city’s infrastructure. Many of the government buildings fell in the quake, including large portions of the national palace. Despite the hundreds of NGO groups working in Haiti at the time, and despite the outpouring of medical and financial aid to help with relief, more than four years after the disaster occurred thousands of people still live in temporary tent cities. Despite the billions of dollars pledged to Haiti’s reconstruction efforts, only a fraction of the money ever arrived, and the first few years after the crisis saw worsening poverty, a cholera outbreak, and political unrest. The earthquake and its aftermath brought into focus in the international media the failures of the system of humanitarian aid in Haiti.

While Haiti and the Dominican Republic share the island of Hispaniola, relations between Haiti, the Dominican Republic, the United States and other economic actors have resulted in hugely differing histories and economies. Haiti’s status as a free black republic in the new world prompted the region’s slave-holding superpowers (namely the

U.S.) to ostracize the nation. Conversely, the Dominican Republic established itself in a

6 more favorable position by collaborating politically and economically with Europe and the U.S., simultaneously upholding a racial hierarchy that privileged lighter skin. As a result of their historical trajectories, Haiti and the Dominican Republic hold opposing relationships to development and economic stability. Haiti is seen as a severely underdeveloped and unstable state whereas the Dominican Republic enjoys a functioning infrastructure and a sugar economy insuring its relative economic health. Antagonism between Haiti and the Dominican Republic has also shaped political and social relations between these states. Long-standing and politically strategic racial discrimination in the

Dominican Republic often makes Haitian immigrants the scapegoats of national anxieties. In spite of this, the productive sugar industry of the Dominican Republic relies almost entirely on Haitian labor, and accusations of human rights abuses from a left- leaning Haitian state have, in more recent decades, added tension to interisland politics.

While the political narratives in media accounts and public historiographies often make this antagonism the central theme of Haitian-Dominican relations, it remains that constructive collaborations also occur both at the individual and community levels. In the border region, many Dominican organizations stand in solidarity with Haitian migrants, many residents rely on their Haitian or Dominican counterparts for trade, fostering amicable relationships across linguistic and national barriers. In fact, the Dominican

Republic was first to respond to the earthquake in 2010, sending supplies and personnel, including the Dominican Red Cross, to dig survivors out from the rubble. While political narratives highlighting anti-Haitian sentiments in the Dominican Republic are by no means totalizing of the relationship between people of both nations, they do suggest a

7 strategic reference to historical antagonisms in order to justify political actions, namely the militarization of the border.

With the outbreak of cholera, an added emergency to the already stressed post- earthquake environment, the border was caught in the headlights of a tense bi-national relationship. Military and public health forces were deployed to the border, where the

Dominican state erected hand-washing stations and migration officials required Haitians to publically wash their hands before entering into the Dominican Republic. Haitians were also subjected to medical exams by public health personnel as they crossed the border. Sinks and health checkpoints at the national boundary made a spectacle of

‘sanitizing’ Haitian bodies, which were interpreted as always already sick, potential cholera carriers. At the same time, media and public health rhetoric played down the spattering of cholera outbreaks within Dominican territory, often challenging the validity of symptoms and almost always tying the disease to Haitians as pathogens.

Plan of the Thesis

The cholera outbreak on the island of Hispaniola exposes the complex and intertwined systems of humanitarian aid, sovereignty and nation building, and historically entrenched geographies of disease. In order to tell the story of how the disease reached the border cinching this island, and how reactions to the illness were formed, I begin by outlining the broad structures of power that set the scene for contemporary crisis, working inward to arrive at the contentious geography of the border. Chapter one traces the rise of humanitarian reason, illuminating the political relationships informing the way aid is

8 distributed to people and places. Chapter two brings the narrative to an epidemiological analysis of cholera, how the disease arrived in the Caribbean in the 21st century, and how the media, nation-states, and NGOs quantified the outbreak. Chapter three looks to the border between Haiti and the Dominican Republic, where notions of the border as a place of symbolic vulnerability clash with the physical vulnerability of contagious disease. The appearances of cholera here illuminate the consequences of both humanitarian impulses and powerful meanings assigned to disease, where abstract imaginings of society and peoples’ place within it solidify in rituals and policies of border crossing.

Two Wings of the Same Bird

As a place where national anxieties are routinely embodied, the border between Haiti and the Dominican Republic has been a site of political tension throughout the history of relations on Hispaniola. Both at the border proper and in the discourses that distinguish between Haitian and Dominican identities, longstanding bi-national relations have shaped political platforms and hairstyles1 alike. The Dominican Republic’s story of independence itself features Haiti as the body from which freedom was won. After declaring independence, the newly sovereign Haitian state sent military forces to occupy the still colonial Santo Domingo in 1822 to prevent the eastern half of the island from being used as a launching pad for a European invasion of Haiti. Pro-independence factions of the elite in Santo Domingo’s capital, upon hearing about Haiti’s intended invasion, declared independence from Spain before Haitian troops reached the colony.

1 See Ginetta Candelario, Black Behind the Ears (2007).

Despite this, the Haitian president, Jean-Pierre Boyer, reasoned that unification of the island would be the best safeguard to independence, and lacking the force or resources to resist, Dominican conspirators acquiesced to Haitian protection of the island of

Hispaniola (cf. Gregory 2007 and Moya Pons 1995). When the Dominican Republic declared its independence for the second time in 1844, it was from Haiti, and as a result, efforts to formulate a national narrative and sense of sovereignty in the Spanish-speaking part of the island hinged on a rejection of Haitian identity.2

Following independence, Haitians came to be seen by Dominicans as backwards, savage, and the antithesis of modernity. While anti-Haitianism was used as political tool during the struggle for independence and in the nation building discourses directly following, anti-Haitian sentiments circulated at first mostly in elite rhetoric. Under the dictatorship of Rafael Leonidas Trujillo (1930-1961), however, resentment against

Haitians became more pronounced and generalized. The border region in particular came under scrutiny from the state as a place of national vulnerability that must be protected from Haitian invasion. After a visit to the borderlands where he witnessed the intertwined communities of Haitians and Dominicans living there, Trujillo sent military troops to the border region with orders to rid Dominican territory of people of Haitian descent. Those who failed to trill the Spanish ‘r’ of the word ‘perejil,’ a linguistic test meant to reveal them as Haitian Kreyol speakers, were killed on the spot. This state-sanctioned Haitian

Massacre of 1937, as Richard Turits (2002) argues, reflected an attempt to bring the border under the control of a centralized Dominican state. The massacre shocked and shattered a previously collaborative and cohesive border society, realigning identities in a

2 This rejection of Haitian identity also allied the Dominican Republic with the United States, which, fearing the ramifications of a nation of freed slaves for its own labor force, had imposed an embargo on Haiti since its independence.

10 way that pitted Dominicans against Haitians, simultaneously setting precedence for militarization of the border by instilling fear of a ‘peaceful invasion’ of Haitian migrants into the Dominican Republic. Similarly, Trujillo instigated development projects in the border region that educated residents in proper Dominican citizenship, an agenda that often emphasized the modernity of the Dominican Republic vis-a-vis the backwardness of Haiti, distinguishing between peoples based on racial constructs.

Yet while anti-Haitianism was used as a tool to solidify the divide between previously collaborative border communities, the way such divides were articulated and acted upon has varied depending on the region and political environment. As Lauren

Derby has written in an historical analysis of racial and cultural constructions in the

Dominican Republic (1994), the way difference is recognized between Haitians and

Dominicans varies depending on whether one stands in the capital or at the border. While difference at the border was tied to cultural disparities in language, labor, and economy, anti-Haitian rhetoric in the capital historically reflected more abstract and politically motivated antagonisms tied to symbolic understandings rather than day to day experiences. Derby argues that such prejudices against Haitians are class based, stemming from the experience of exploited labor conditions of Haitians in the sugar industry of the Dominican Republic.

In more recent decades, migration and labor disputes have further strained relations between the two countries of Hispaniola. Under the infamous Haitian dictator,

François Duvalier,3 known for his brutal tactics of political repression and for the amount of money that flowed from public funds into his family’s pocket, the two nations signed

3 François Duvalier, also known as ‘Papa Doc,’ was elected president of Haiti in 1957 on a populist platform. He ruled the nation through violence until his death in 1971. His son, Jean-Claude Duvalier, also known as ‘Baby Doc,’ succeeded him as president until he was overthrown by a popular rebellion in 1986.

11 labor contracts that funneled Haitian workers into the Dominican sugar cane fields. After an investigation of the conditions of work Haitian laborers were subjected to, human rights organizations such as Americas Watch and the Lawyers Committee for Human

Rights condemned conditions in the sugar camps, citing slave-like conditions (Martínez

1995: 50). Despite the Dominican sugar industry’s reliance on Haitian labor, mass deportations and expulsions of Haitians from the Dominican Republic have occurred since the late 1980’s on multiple occasions in response to international pressure to improve labor conditions or political disagreements between the two nations.

In 1991, with the United Nations as his audience, Jean-Bertrand Aristide, Haiti’s first elected president following the brutal dictatorship of the Duvalier family and several years of a transitional military government, denounced the slave-like labor conditions for

Haitian migrants working in the Dominican Republic. Switching from French to Spanish to directly address Haiti’s neighboring nation, Aristide proclaimed, “Haiti and the

Dominican Republic are two wings of the same bird, two nations that share the beautiful island of Hispaniola. Hearing the voice of all the victims whose rights are trampled, engaged in respecting human rights despite the social problems and financial difficulties created by this forceful repatriation, we must respect both wings of the bird…” (quoted in

Wucker 136). While this part of his speech was clearly directed toward the Dominican state and its ongoing exploitation of Haitian labor, Aristide was doubtlessly aware of the political influence of his immediate audience, the United Nations. In a call to action to stop human rights abuses of immigrant labor, Arisitide presented the issue on a global stage, tapping into a regime of humanitarian reason that has come to structure political

12 relations.4 The context and hoped-for consequences of this pronouncement illustrate well how the contemporary relationship between Haiti and the Dominican Republic is one mediated by an international audience. Conversations and politics between the two nations of Hispaniola have historically occurred on an international stage, both shaped and influenced by broader political and economic interests.

A Republic of NGOs

Today, more than two centuries after the French colony of Saint Domingue earned its reputation as the richest colony in the new world, newscasters begin reports from Haiti by introducing it as the poorest nation in the Western Hemisphere. Haiti has the greatest number of NGOs per capita, a phenomenon prompting Paul Farmer to refer to the post- earthquake nation as a “Republic of NGOs” (2011: 4). While the earthquake has brought to light the privatization of Haiti’s public sector and the sheer density of humanitarian organizations in the nation, the intensified presence of NGOs can only be appreciated within the context of Haiti’s historical relationships with aid and intervention.

Despite the lack of a formal diplomatic relationship, Americans and Europeans traded with Haiti for the first century of its independence. When a series of coups in Haiti threatened investments in the nation, the US sent in the Marines to take control of the customs houses, insuring continued profits from the nation and beginning a 19-year occupation that would leave its mark on Haiti’s banks and politics.5 Even after the departure of US troops from Haitian territory, the economic elite and military forces who

4 See Didier Fassin (2012) Humanitarian Reason, for a discussion of this regime of logic. 5 A second U.S. military occupation of Haitian territory occurred in 1994-1995 after the coup d’état that overthrew President Aristide.

13 controlled the Haitian state had firm US support, paving the way for the rise of the

Duvalier family, who ruled Haiti until Jean-Claude Duvalier was overthrown in 1986 by a popular revolt. After four years of a transitional military government, the Haitian public elected Jean-Bertrand Aristide in 1990. The election of Aristide, despite its precariousness at first, represented a move towards political and civil rights for Haiti’s majority, a population that had been perpetually abused and persecuted under the

Duvaliers.

In a political and economic environment of U.S. resistance to the populist and left-leaning policies of President Aristide, humanitarian aid in Haiti took shape.

Disapproving of Haiti’s left-leaning elected government, US assistance flowed to NGOs and private organizations working in Haiti rather than to the public sector (Farmer 2011:

135). In 1995 a conservative US Congress voted to redirect USAID funding away from the Haitian government, supporting instead NGOs working in the country. Two years later, the World Bank suspended any new loans to the Haitian government, justifying the embargo by claiming the lack of an elected parliament (Schuller 2012: 23). In 2004, as

President Aristide’s second term was interrupted by an armed conflict, an event whose initiatives and support are still contested, the United Nations Peacekeeping Force in Haiti

(MINUSTAH) was established by the UN Security Council. The mission deployed military, police, and civilian personnel to insure security and stability in Haiti, acting as a police force and monitoring elections.

Largely as a result of the huge amount of money donated to extra-governmental organizations working in Haiti, the nation has become an epicenter for the development of what Ricardo Seitenfus, Organization of American States (OAS) representative to

Haiti, terms a ‘training ground’ for amateur NGOs (quoted in Robert 2010). In a similar perspective, many have described the situation of aid in Haiti as constituting a parallel state, a phenomenon of development aid theorized by James Ferguson (1990), where

NGOs vie for political clout and often further disable the state and public sector by fracturing attempts to build infrastructure (cf. Farmer 2011; Katz 2013; Schuller 2012).

Since the 2010 earthquake that leveled the Haitian capital city, NGO aid has further expanded in the country. The earthquake destroyed government buildings and facilities, killing or wounding many state officials and further crippling efforts of the Haitian government to provide infrastructure or support to populations effected by the quake.

International campaigns to raise funds for earthquake relief have channeled private and public donations to non-governmental aid organizations, many of which provide medical care, temporary housing, food and drinking water to populations effected by the disaster.

Popular discourses today claim that the U.S. has been the largest donor to Haiti for more than three decades. In the aftermath of the earthquake, a U.S. public that had donated en masse to the relief efforts demanded to know how less than 1% of their donations had made it “to Haiti.” At the same time, President Michel Martelly, frustrated with the aid attempts proclaimed, “We don’t want the money to come to Haiti. Stop sending money. Let’s fix it. Let’s fix it” (quoted in Beaubien 2013). Reports attempting to track the flow of funds following the earthquake have noted that of every $100 awarded by the U.S. government to Haiti for reconstruction, $98.40 has gone to

American businesses, a trend that emphasizes the potential for profit in post-crisis reconstruction (Doucet 2011). If a disillusioned President Martelly would go so far as to demand the U.S. stop sending money to Haiti altogether, and if, despite the abundance of

15 economic aid pledged by the U.S., such a small portion of funds have been traced to reconstruction projects, how are we to reconcile the impulses of humanitarianism with their damaging effects on a nation’s sovereignty? As Haiti’s closest neighbor and a state intricately entwined with flows of labor on the island, the Dominican Republic has undeniably witnessed the process and consequences of Haiti’s NGO dependence.

The reaction of the international community to Haiti’s earthquake in January 2010 was, foreseeably, to amplify the presence of relief in the nation. The Red Cross, Doctors

Without Borders, USAID, and the United Nations Stabilization Effort in Haiti

(MINUSTAH, Mission des Nations Unies pour la stabilisation en Haïti) were only a few of the entities that reacted to the crisis, sending in medical supplies, personnel, and emergency infrastructures to help with the immediate crisis of earthquake victims. Nine months after the tide of international organizations that mobilized in response to disaster, in late October of 2010 reports of cholera surfaced in Haiti. Many immediately understood the disease to be endemic, a consequence of the damage wrought by the earthquake on an already inadequate water infrastructure. While poor infrastructure can be partly blamed for precipitating the crisis, it remains that cholera was brought to Haiti by Nepalese UN Peacekeepers stationed on the island to monitor earthquake recovery. In other words, the disease stemmed from the very system of aid and intervention meant to bring health and order to the country—an issue I will return to below.

The Dominican government reacted swiftly to the news of a cholera outbreak in

Haiti. In October of 2010, 1,500 soldiers of the National Army of the Dominican

Republic, along with hundreds of public health professionals, were stationed along the

16 most ‘vulnerable’ parts of the Dominican-Haitian border. Their militant presence was meant to close the border, preventing the invasion of cholera, which had already killed two hundred and infected more than two thousand people in Haiti. Military action was taken, in the words of the head of the Dominican armed forces, “to definitively seal the border,” making it impossible for Haitians to cross into the Dominican Republic (Urbáez

2010). While sealing the border received much press attention, it was a short-lived tactic, and less than a month later the bridge was back open for business, namely, the business of the bi-national marketplace in Dajabón. The performance of military force at the national frontier contained both visual and symbolic resonance for a nation that often perceives its borders as holding back a tide of people and structural troubles from Haiti, especially in times of crisis. After the crisis was averted, the border remained under media scrutiny; mobile sinks were erected and migration authorities required all Haitians crossing the border to wash their hands in chlorinated water before entering the

Dominican Republic.

The cholera outbreak in Haiti was an astounding gaffe of humanitarian aid, but one that unveils a host of assumptions, systemic rationalities, and dangerous blind spots in the way aid is conducted through transnational flows of people, resources and information. The site of the border between the two nations of Hispaniola and the public health performances enacted here bring to stark contrast the inequalities between Haiti and the Dominican Republic. The imagination of humanitarian reason as a global enterprise attends to (and magnifies) suffering in Haiti in a way that creates subjects in need of perpetual intervention and regulation. Besides facilitating the flow of aid to the nation, the image of Haitians as helpless and deprived also articulates with Dominican

17 discourses of national identity that have often been constructed in opposition to Haitian identities. Anti-Haitian sentiments and policies have resonated with a Dominican public since elites undertook nation-building tactics to bring the borderland’s economy under the wing of the state. Since the 1940’s with the state-sponsored ‘Dominicanization of the

Border,’ where the Dominican government implemented public works projects to regulate border communities, popular discourses of identity in the Dominican Republic have emphasized Spanish, not African heritage, Spanish not Kreyol, and Christian, not vodou practices to highlight the contrast between Haitian poverty and Dominican modernity. By casting Haitians as individuals suffering from general chaos and lack of hygiene, Dominican narratives tend to buff up their image as self-sustaining, controlled and well-educated sanitary subjects.

This thesis explores the consequences of what Charles Briggs (2003) calls

‘sanitary citizenship’ on Hispaniola. Narratives and modern health measures of cholera codify disease in a way that divides people into groups either possessing or lacking modern medical understandings of illness and the body. Characteristics of sanitary citizenship become welded to race, class, and gender in ways that facilitate discrimination based on social status. Where Briggs takes a socially and politically marginalized region of Venezuela as the site of his inquiry, I explore here the physical margin of the nation, the border, as a site where the state materializes in an attempt to keep disease outside the boundaries of the nation-state. The border between Haiti and the Dominican Republic offers a unique region from which to explore modern notions and practices of health on various fronts. The historic tensions between Haitian and Dominican identities, the contradictory discourse about immigration, and the realities of border communities play

18 out in an unequally globalizing context at the border. The uniforms of border authorities illustrate this unequal representation, where Dominican military fatigues mirror the UN

Casques Bleus (blue helmets) on the Haitian side. Dominican attempts to narrate their own national identity in relation to the Haitian ‘other’ now grate against a nation saturated with international humanitarian aid. This thesis explores what it might mean to construct national identity in relation to a ‘Republic of NGO’s’ (Farmer 2011), and how cholera, “a disease of modernity, globalization, and social inequality” (Briggs 2003: 8) might make its mark on a deeply contested border.

CHAPTER ONE

THE SYSTEMATICS OF HUMANITARIAN AID

The system, just like cholera, cannot be touched with your hand, but you can feel it in your limbs -Karl Bürkli

The origins of cholera in Haiti reveal problematics of military-humanitarian aid, a phenomenon both inspired by and perpetuated in globalizing economies and political relations. Fearing post-disaster chaos in Haiti, the UN made the decision to increase the number of troops present in the nation (Resolution 1908 (2010)), and these troops, or the individuals they comprised of, acted unintentionally as vehicles of cholera. This seemingly simple cause-and-effect relationship between the 2010 earthquake, increased international presence, and cholera has to be seen within the much larger and historically rooted web of geographical perceptions, unequal relations, and political ecologies of disease. By historically and politically contextualizing the forces that facilitated the cholera outbreak, we can begin to interpret this public health disaster as the product of a global system, rather than an unfortunate coincidence.

As the American vestige of the ‘dark continent’ of Africa, Haiti often shoulders the brunt of media assumptions and rumors of disease. These assumptions often stem from the way media and international discourses locate Haiti in relation to other nations or regions. Paul Farmer has explored popular understandings about Haiti that peg the nation as the source of disease and chaos. In a cartography of rumors and misconceptions

20 stemming largely from racial stigma, Farmer maps out the ‘geography of blame’ that led media and scientific spokespersons alike to peg Haiti as the source of AIDS (1992). In the early 80’s as the AIDS pandemic was emerging in the US and across the globe, a number of Haitians from urban areas fell ill with the opportunistic infections that characterized the emerging syndrome. As the disease gained momentum in the U.S., epidemiologists and media both looked to Haiti as the mysterious source of such an outbreak. In the 1980’s with the AIDS pandemic, the US Centers for Disease Control identified Haitians as a ‘risk group,’—one of the four H’s with homosexuals, heroin users, and hemophiliacs. Haitian immigrants to the US found it increasingly difficult to find jobs or send their children to public schools as a result of the stigma identifying them as a population at risk for AIDS. Haitians who fled the violent dictatorship of Duvalier and sought asylum in the U.S. were dubbed ‘economic refugees’ and deported.

Discourses of blame hyper-pathologized aspects of Haitian culture, some based in actual practices, but many filtered through Hollywood depictions of vodou and political mayhem.

The AIDS pandemic revealed how anxieties about race and danger that have characterized Haiti’s relationship to the world since independence, and that continue to resonate in US immigration policies, often become tied to disease. Farmer traces these structures of exclusion, claiming “Haiti has long been depicted as a strange and hopelessly diseased country remarkable chiefly for its extreme isolation from the rest of the civilized world” (1992: 4). These accusations, centering on health, transform Haitian bodies into publicly legible bodies in the context of both political and epidemiological anxieties. Haitian migrants are made to embody geographically imagined ills, and within

21 this system of legibility, other traits, cultural or racial, become readily fused to disease.

‘Black,’ comes to be read as ‘Haitian,’ which comes to be read as ‘sick.’ Similarly, the

Dominican reaction to the recent cholera outbreak identified ethnicity and nationality as risk factors at the border, reiterating the pervasive logic of disease geography at play in

U.S. regional relations.

In a similar vein, Laura Briggs ties contemporary conceptions and assumptions of illness to colonial power structures. She argues that the relationship between colonizer and colonized often depended on the language of disease (2002). Where the success of colonization and a fixed hierarchy of power depended on the ability of the colonizer to survive ‘the tropics,’ pathological superiority became one of many tools of submission. It is perhaps this history that informs today’s perceptions of global health. The linear model of ‘progress’ in development discourse (a model founded in colonial relationships) lumps together economic productivity, political stability, infrastructure and public health in a way that assumes the starting line to be a chaotic and unhygienic viral free-for-all. By this logic, Haiti’s current lack of political or economic stability led many to see diseases like cholera as a “part of the impoverished country’s landscape, a result of the squalid living conditions that many Haitians found themselves in after the country’s massive 2010 earthquake “ (Katz 2012). In a media and popular rationality driven by pathologized geographical misconceptions, the stage was already set when cholera broke out in Haiti.

Blame for the outbreak was assigned based on an internationally imagined ‘local biology’ of the region. As a financially struggling, postcolonial, and predominantly black republic,

Haiti embodied a landscape that was interpreted as always already sick.

This clinical understanding Haiti has consequences beyond skewed media discourses. These assumptions, and the resulting construction of ‘suffering’ in this context, invite military-humanitarian interventions to ‘fix’ problems of a particular kind.

Jean and John Comaroff have traced this medical alibi for intervention to foreign policy in the case of colonial British Africa, where the rise of biomedicine was inseparable from the cultural (and economic) enterprise of British conquest. The birth of clinical medicine instituted the objectifying gaze, where the subjectivity of the patient disappeared behind the impulse of positive science (Foucault 1963). As the bodies of colonized populations played into medicalized narratives about affliction, the impulse of the clinical gaze is to see without context, creating patients in colonial Africa rather than a contextualized population of subjects. In this way, “medicine drew upon social images to mediate physical realities, giving colonial power relations an alibi in the ailing human body”

(Comaroff 1992: 216). Even before the global explosion of humanitarian aid, outside interventions into colonized spaces used “metaphors of healing [to] justify ‘humane imperialism,’ making of it a heroic response rather than an enterprise of political and economic self-interest” (Comaroff 1992: 222). The images of economic, medical, and political ‘ills’ in contemporary Haiti similarly facilitate the hundreds of NGO operations, multiple US military occupations, and current MINUSTAH presence in the nation, a bricolage of aid that undermines autonomous infrastructure.

While colonial discourses used the clinical gaze to create ‘patients’ instead of colonized subjects, contemporary aid impulses also work to decontextualize regions and peoples. Liisa Malkki refers to this relationship as “clinical humanitarianism,” whereby populations are described in statistics that speak to the logic of a global aid framework

(1996: 390). Resonating with this colonial legacy, modern humanitarian intervention similarly bases its legitimacy on a universal western morality, where new forms of humane imperialism perpetuate unequal relationships of power. Constructions of Haiti, for example, as an isolated and poverty-stricken nation are detached from the historic context that structures race relations on the island and in the region, relations that are used to position the Dominican Republic as a whiter and therefore more modern nation.

Humanitarian Reason

The workings of global politics and the logic driving interventions have increasingly become dependent upon notions of morality and humanitarian reason. Didier Fassin maps the underpinnings of the contemporary moral economy, where “our way of apprehending the world results from a historical process of ‘problematization’ through which we come to describe and interpret that world in a certain way, bringing problems into existence and giving them specific form” (2012: 7). By this logic, Haiti’s earthquake and public health disaster came to be seen as one ‘problem’ that merited more attention or intervention than others. Fassin suggests that underlying each call for humanitarian action is an incentive that fits our present political or economic agendas. In this moral economy, Haiti as a nation of sufferers merits more attention and action than does the Dominican Republic.

Similar to Farmer’s geographies of blame, Fassin points to moral geographies that influence how and where humanitarian aid is distributed. He writes that humanitarian intervention depends upon the production of representations, public narratives that portray certain groups of people as sufferers or victims instead of active agents within

24 their context (Fassin 2007). Drawing from Fassin’s work on the way humanitarian reasoning functions in contemporary political relations, we can interpret how Haiti, dramatically referred to as the poorest nation in the western hemisphere even before the earthquake and cholera outbreak, warrants the humanitarian impulse in today’s global political regime in a way that the Dominican Republic does not. As a consequence of this rationalization, the Dominican Republic and outbreaks of disease occurring there are made less visible both by an international press fixated on Haiti’s ills and by the

Dominican state seeking to assert its modernity in relation to Haiti.

Creating the Sufferer

This new humanitarian rationale described by Fassin relies on media depictions of disaster and suffering, first to inspire compassion that legitimizes intervention, but also in securing the economic stability of aid organizations. Leslie Butt has demonstrated compellingly how stories and images of people suffering in contemporary media are meant to inspire compassionate reactions in a global audience while their discourses simultaneously “mask a set of assumptions about global moralities” (2002: 3). Regimes of humanitarian reason, she would argue, create the sufferer in an image that ultimately validates the sustained dependency of some parts of the world on other parts of the world.

While the media has played a crucial role in constructing the ‘suffering stranger,’ images, stories, and consumer cultures work paradoxically to bring first world aid donors closer to their receptors. Many middle class Americans have photos of young children in Africa or Latin America that they have ‘adopted.’ Many channel a monthly funding package to

25 these individuals in order to improve their lives, or buy a cow or chicken from Oxfam

International for a family ‘in need.’ Public participation in the new humanitarian order hinges upon what Renée Fox calls the “mediatization” and “theatricalization of human disaster” (1995: 1612). Taking these theoretical perspectives into consideration makes legible the media discourses and the flood of images that followed both the earthquake and cholera outbreak in Haiti. Much of the aid secured from the public depended on these images of disaster and on a public sense of universal human rights lacking in this situation. UN Secretary General Ban Ki-moon, following the cholera outbreak, spoke in support of the UN aid in Haiti, simultaneously calling on the international community to provide aid, proclaiming,

We cannot think short-term in our response. Millions of people look to us for immediate survival. At the same time, our response must be viewed within the broader context of recovery and long-term development. Investment in basic infrastructure is critical – clean water, sanitation, healthcare and education, durable shelter and employment. Without it, Haiti has no sustainable future, no hope for a better future. The Secretary General, besides very clearly painting a picture of a suffering populace in need of immediate outside assistance, places MINUSTAH, an armed force, in the center of humanitarian action in Haiti as the body facilitating and mediating aid coming into the nation. This depiction of the ‘suffering stranger’ in Haiti doesn’t stop in its construction of the needy. This discourse includes an image of a military force as the heroic structure for which the situation calls. How do notions of humanitarian intervention and aid become entwined within military metaphors and realities?

Intervention and Militarization

As many have argued, the humanitarian moralities that permeate political decision- making often take on aggressive forms (cf. Fassin 2012; Ferguson 1990; Fox 1995). The type of response called for by such a morality is “heroically aggressive, ‘warrior-like,’ medical action, that is also ‘masculine’ and doctor-centered in its ethos and self- presentation” (Fox 1609). Military metaphors used to describe humanitarian aid construct an image of “a single, unitary, righteous army doing battle against a universal enemy”

(Ferguson 1990: 65). The United Nations Peacekeeping Mission in Haiti, MINUSTAH, is perhaps the most salient representation of military intervention supported by humanitarian discourse. While first deployed to Haiti to “support the Transitional

Government in ensuring a secure and stable environment,” MINUSTAH also narrates its roles as supporting “Haitian human rights institutions and groups in their efforts to promote and protect human rights; and to monitor and report on the human rights situation in the country” (“MINUSTAH Background” UN website). It seems contradictory that a peacekeeping mission consist of armed troops, yet within this ethos of humanitarian reason, which narrates disasters and human rights emergencies as

‘battles’ against suffering, armed forces constitute the logical body to carry out this kind of aid.6

6 In the UN’s peacekeeping mission in Haiti, many of the countries sending troops have a less developed infrastructure. Nepal constitutes one of the sixth largest contributors to the UN’s MINUSTAH body, and for every peacekeeper deployed the UN pays home countries a little more than $1,000 per month (“Financing Peacekeeping” UN website), significantly more than the pay for a private in Nepal. The Nepalese state requires peacekeeping soldiers to contribute a fourth of their pay to a general welfare fund for soldiers (Katz 2013). This suggests that by contributing personnel to the MINUSTAH force, nations like Nepal, whose main export is labor, gain substantial financial benefits. Nepal, like Haiti, lacks solid water infrastructure, and soldiers sent to Haiti who imported cholera fit into a system of aid, labor and economy that allowed for the outbreak to occur (Health Roots Student Organization 2011).

Post-earthquake Haiti, much like post-Katrina New Orleans,7 has served as the territory from which both private and state agencies practice a new type of governmentality. A ‘Republic of NGO’s,’ the western nation of the island of Hispaniola has been assimilated into a system of humanitarian governmentality, where contemporary politics revolve around aid and intervention. As we decipher the system of humanitarian aid playing out in contemporary politics we must also pay careful attention to those places who fall into the shadows of the objectifying limelight of aid. Despite the fact that humanitarian aid and reason have become transnational enterprise, the object of their aid still often falls within the boundaries of the nation state. I have illustrated how Haiti as a geographical and imagined place on a map functions (and is made to function) in global humanitarian politics. Haiti looms so large in the humanitarian imagination that it monopolizes international focus to the detriment of the neighboring Dominican Republic, which lacks the same capacity to inspire compassion. Where Haiti functions as the poster child of humanitarian aid, this humanitarian system overlooks Haiti’s neighboring state, which is seen mostly as a tourist destination. While the Dominican Republic has not been made to function as a recipient of humanitarian aid in the way that Haiti has, the logics of humanitarian reason have particular effects, ones that come to the surface in the event of public health crisis. The border where these two places grate together reveal how disease cannot be made to adhere to national boundaries, and how the hyper-victim narratives about Haiti result in public health silences in the Dominican Republic. Humanitarian aid in Haiti sets up boundaries for itself that are drawn by historicized assumptions and

7 See Vincanne Adams (2013) Markets of Sorrow, Labors of Faith for a discussion of how humanitarian relief has been transformed into a lucrative business for private companies in New Orleans after Katrina.

28 international relationships, but what happens when the object of aid, in this case cholera, fails to adhere to these boundaries?

CHAPTER TWO HOW CHOLERA CAME TO HISPANIOLA

Cholera occupies a particularly resonant position in our cultural imaginary, where epidemics have served as the backdrop for various novels from Europe and Latin

America alike. The characters of Jean Giono’s The Horseman on the Roof as well as

Gabriel García Márquez’s Love in the Time of Cholera battle the illness’s chaotic effects as they themselves embody the triumph of progress and modernity. The disease often serves as a point of reference, the context within which social order is heroically restored by the protagonist. Susan Sontag has written extensively on the metaphors and symbolism associated with disease and how such metaphors serve to justify particular responses to the threat of illness, to make judgments about the characteristics of the afflicted, or to assign certain moralities to disease (1978; 1989). Cholera inspires a host of judgments regarding the modernity and sanitation of those groups it afflicts. Populations that contract cholera are often understood to live in perpetual poverty, lacking in the sanitary and hygienic practices of modernity. This symbolic understanding of the disease, along with geographies of blame surrounding Haiti inform international understandings of the disease, shaping media perspectives, like that of a British Medical Journal reporter, who asked during a press conference; “How, despite ‘the appalling conditions of the people in the capital,’ had there not been a cholera outbreak in Haiti before?” (Katz 2013:

224).

The last case of cholera on Hispaniola occurred more than a century prior to the

2010 outbreak. During the 19th century, the Haitian state took careful measures to lessen the threat of cholera from maritime trade with the U.S. and Europe by encouraging a cordon sanitaire in port cities. Even as a cholera outbreak occurred in the Dominican

Republic in 1867, there were no signs of the disease having spread to Haiti. Given the outbreaks of cholera on most of the Caribbean islands in the 1800’s, Haiti’s blank epidemiological record made it the exception in the region. This absence has been attributed in part to Haiti’s lack of plantation slavery and colonial military troops after its independence in 1804 (Jenson and Szabo 2011); unlike in other Caribbean colonies, Haiti did not have a diverse imported population until recent decades with the flood of NGOs and the UN Peacekeeping Force. Haiti and the Dominican Republic both escaped the last epidemic that began in Peru, affecting much of Central and South America.

The absence of cholera in the country until 2010 didn’t fit with people’s expectations of Haiti as a disease-ridden country. Both media sources and aid personnel held presumptions about the chaotic possibilities of disease outbreaks. One NGO president working in Haiti claimed, “we have been afraid of [a cholera outbreak] since the earthquake” (AL Jazeera 2010). The expectations about the health of Haiti go beyond the absence of advanced water treatment and sanitation practices that make the country vulnerable to cholera. In our moral imagination, Haiti is a country of “unsanitary subjects” who are “judged to be incapable of adopting [a] modern medical relationship to the body, hygiene, illness, and healing” (Briggs 2003: 10) and as such, a prime candidate for a cholera outbreak.

Following the 2010 earthquake, the United Nations Peacekeeping Force in Haiti

(MINUSTAH) responded to what they perceived as a heightened security threat in the

nation. The number of troops and police personnel was augmented and Nepalese soldiers

training in Katmandu were brought into Haiti, stationed along the Artibonite River near

Figure 1: Map of first cases of cholera in Haiti, from

the town of Mirabalais. While the region of Nepal where the soldiers originated was well

known for being cholera endemic, Nepalese troops were not screened for the disease,

upholding the UN protocol of not testing people for cholera who failed to display

symptoms of the disease. As they arrived to Haiti in early October 2010, these troops

encountered a faulty infrastructure and sewage system within their camp,8 and as a result,

cholera-infested fecal waste from this site flowed into the Meille Tributary System, a

waterway that feeds the Artibonite River, rapidly infecting communities downstream.

8 A private company contracted by the UN handled the disposal of waste from septic tanks at the Nepalese MINUSTAH base. While the UN has said the company was responsible for poor drainage, Sanco Enterprises S.A. claims the UN established protocol for waste disposal (cf. Katz 2013; Engler 2011).

Epidemiology of Cholera

Cholera is caused by the bacterium Vibrio cholerae. The toxin produced by this bacteria blocks the cells in the intestine that absorb water and electrolytes, prompting the intestines to secrete fluids and resulting in extreme diarrhea and vomiting that leaves victims severely dehydrated. One of the fastest bacterial killers, cholera symptoms can kill victims in a matter of hours if untreated, causing some people to loose 10% of their body weight in as little as three hours. People are infected with cholera by ingesting food or water infested with the bacterium, usually spread through feces. According to the

World Health Organization, most people infected with the bacterium do not become gravely ill, and the rapid and deadly dehydration we associate with the disease occurs in less than 20% of cholera cases. Often, the bacterium has less severe effects, causing mild but not deadly diarrhea and vomiting. For this reason, 80-90% of cholera episodes can be difficult to distinguish from other types of diarrheal diseases or afflictions.

Cholera, believed to have originated in India, first broke into a pandemic in 1817 when it spread across Asia killing thousands before disappearing in 1824. Subsequent outbreaks spread around the world, including the Americas, until 1923. Epidemiology points to a fissure between this last pandemic (the old pandemic), and the spread of cholera that began in 1961. This new pandemic, the seventh, was caused by a different strain of bacteria called El Tor, and in 1991 this bacteria reached the coast of Peru, sparking a pandemic that touched most of continental America (PAHO 2012). The

Caribbean, however, was spared in this outbreak, with no reported cases in Haiti, the

Dominican Republic, Cuba, or any other island of the Caribbean according to the Pan

American Health Organization.

In October of 2010, the number of cholera cases caused by El Tor in Katmandu,

Nepal, was reported to be on the rise, compelling health officials to warn of a potential outbreak there (Maharjan 2010). On October 9th, 12th, and 16th, Nepalese troops based in

Katmandu arrived in Haiti’s central valley as part of the newly expanded UN

Peacekeeping Force in Haiti (Katz 2013: 230). Despite warnings of a potential outbreak in Nepal, health officials did not consider the possibility that Nepalese peacekeepers sent on foreign missions would serve as a vector of the disease, contaminating the populations they were meant to protect. As a result, less than two weeks after the first Nepalese troops arrived in central Haiti in 2010, the Haitian government reported a wave of cholera cases on October 22 in Mirebalais. Cholera spread downstream towards the coast and towards the capital, infecting regions along the Artibonite River. By the end of October, the first cases of cholera were reported in Port-au-Prince.

As is often the case, Haiti’s cholera outbreak was attributed to a lack of infrastructure, yet in responding to the crisis, humanitarian and international aid organizations targeted individual behavior, focusing on “prevention by ensuring clean water, promoting good personal hygiene, and food handling practices, including hand washing and trying to prevent defecation in open areas” (WHO Global Alert and

Response, 2010). Public health infrastructures and their failings, in this type of reaction, were overlooked in the rush to stop the spread of the disease despite the fact that infrastructure, not individual behavior, had instigated the outbreak. Immediate reactions to the outbreak highlighted the individual actions of people susceptible to the disease,

34 encouraging particular hygienic practices for a largely displaced and poor population.

The lack of hygiene associated with poverty and social inequality is seen as also indicating a lack of modernity. At risk people’s individual practices became the arena of intervention in posters and public health publications that identified washing hands, purifying water, and boiling food as ways to avoid cholera infection. These posters, meant to educate people about the spread of cholera, ran the risk of associating disease with negative attributes or hygienic practices rather than infrastructural failures. The tendency to associate risk of infection with assumptions about hygienic practices were reflected in the technologies of health intervention at the border, where migration

Figure 2: Dominican Red Cross poster showing symptoms and ways to avoid cholera. Picture taken by author in Pedernales, Dominican Republic. officials adopted these techniques, requiring Haitians crossing into the Dominican

Republic to wash their hands, wade through chlorinated water or undergo medical exams.

The ‘After-math’ of Disaster

Numbers, and the way they are mapped onto regions, nations, people, and economic differences reveal much about how cholera as a bacterium is made to embody a host of meanings based on the context from which it emerges. Statistics and their forms of representation remain a key technology in the legitimization of public health institutions, yet the seemingly incontrovertible truth they are assumed to portray is a product more of the system in which numbers are produced and mobilized rather than the experiences of disease. As Diane Nelson argues, “counting does the special work of making visible what was ‘already there,’ but it also produces what it seems to simply show” (2013). Counting cholera in the “after-math” of disaster (Nelson 2013) constituted a way to generate comparisons. While many NGO and international agencies working in

Haiti generated and published numbers with the hopes of garnering financial and political support for medical aid to respond to the crisis, interests of the Dominican state were to keep cases of cholera out of the national territory. In looking to the numbers, statistics, and quantitative images produced in counting cholera, we see how two regimes of logic yield disease measurements based on interests and intentions that converge and clash at the border.

The System That Generates Numbers

On the Haitian end of the island, where non governmental medical aid already constituted an extensive body of professionals in the nation, cholera cases were quickly pinpointed, recorded and reported in the official statistics of the World Health

Organization (WHO) as well as in the estimates of organizations like Doctors Without

Borders and USAID. I have argued above that the influence of humanitarian reason and politics in Haiti has resulted in a ‘Republic of NGOs,’ a bureaucracy of aid that reproduces itself by reproducing the ‘suffering stranger’ in order to secure funding. The cholera outbreak and force with which it hit Haiti resonated with the imagined geographies of disease held by an international audience accustomed to regarding Haiti as lacking in sanitary modernity. Similarly, the outbreak seemed to support the need for external aid to Haiti, demonstrating less than a year after the earthquake the extreme vulnerability of the Haitian population. In this way, the statistics produced to quantify the cholera outbreak seemed to uphold notions of the state of emergency that justified the presence of hundreds of NGOs. Maps and media reports on the disease read; “Cholera

Intensifies its Grip on Haiti” (Figure 2), and “A Worsening Haitian Tragedy” (New York

Times), reiterating a discourse of victimization already prevalent in the mediatization of humanitarian aid.

Figure 3: Map of cholera aid to Haiti, from USAID Where governing bodies (public or private) in Haiti may have produced statistics in a way that indicated a need for aid, the Dominican Republic managed and reported cholera cases with very differently. Instead of dramatizing outbreaks on Dominican territory, Dominican press reported potential cholera cases selectively and often with uncertainty. Reports of patients hospitalized with severe diarrhea rarely confirmed the cholera bacterium, and media coverage focused on the state’s attempts to prevent cholera from crossing the border into the Dominican Republic. Where numbers had been a crucial and visible aspect of reporting cholera in Haiti, statistics were noticeably missing from many Dominican media reports. National press reported the priorities of the Public

Health authority, “to maintain epidemiological control, providing timely and accurate information in order to avoid misinformation and alarm about the progress of the disease”

(El Nuevo Diario 2010, my translation). As several cases of cholera did arise in the

Dominic Republic, the Dominican minister of public health emphasized the lack of transmission within the country, assuring the public that “the situation was of absolute calm” (El Nuevo Diario 2010).

Figure 4: Map of cholera cases and populations

Figure 5: Map of cholera outbreak from Center for Disease Control

Seeing the cholera numbers contextually also demonstrates the extent to which the geography of states play into the way statistics are imagined and produced. The number of cholera cases and their geographic location in both nations of Hispaniola were counted based on particular territories, be they departments in the case of Haiti or provinces in the Dominican Republic. Most of the visual representations of cholera’s spread produced by private, public, or international organizations portrayed either Haiti or the Dominican Republic. These maps gave added meaning to the border between these two nations, depicting it as epidemiologically impenetrable, the boundary holding the disease within Haiti. These illustrations further encouraged particular judgments about populations falling within politically made boundaries. Haiti, a nation most recognized for its lack of development, lack of sanitation, and lack of order, was isolated in these illustrations, trapping cholera within its own national boundaries. Conversely, the

Dominican Republic often remained outside the visual danger zone depicted in the map, often not even featured in the frame of the image. Maps of the epidemic, and the statistics they purportedly reflected, reproduced both the system whereby disease is understood to occur within the borders of a nation and where disease constitutes a powerful way of imagining and measuring the modernity of certain spaces.

Figure 6: Cholera attack rate for Dominican Republic, from Ministry of Public Health, DR

What the Numbers Produced

The production of statistics and the use of numerical information to quantify cholera occurred on many different fronts. Within the regulated standards of the World

Health Organization and its regional branch, the Pan American Health Organization

(PAHO), “nation-states secure the right to exercise control over the production of health

41 statistics within their borders” (Briggs 2003: 258). Although the Haitian Ministry of

Public Health controlled the statistics reported to PAHO, many NGOs had the resources and structures to do the counting in the first place. The overlap between the state’s public health body and the non-governmental organizations also collecting statistics resulted in many alternative publications of these numbers as well. NGOs published their own maps of the epidemic and gave their own numbers to reporters, in addition to their collaborations with the state. In this way, the statistics produced about the cholera outbreak in Haiti, influenced by the logic and interests of the humanitarian impulse, reproduced the flow of aid to NGOs there, citing compelling evidence about the need for response to yet another crisis.

The power of disease to assign meaning to territory played out again in the

Dominican context, but while cholera reaffirmed the international imaginary of Haiti as already sick, on the Dominican side it reaffirmed the border as a place of national vulnerability. Of the 21,592 cases of cholera in the Dominican Republic reported to

PAHO, 3,385 occurred in provinces sharing a border with Haiti (PAHO 2012).9 While more cases occurred in higher density provinces, the border held the limelight of state reactions to the crisis, undergoing heightened sanitary surveillance and serving as a symbolic battleground where the state held back the flood of cholera coming from Haiti.

In the National Plan for the Elimination of Cholera in the Dominican Republic, the

Ministry of Public Health tied disease risk to geography, claiming, “the four very high risk provinces are located near the border… due to increased vulnerability and poverty”

(2012: 8).

9 While the percentage of cholera cases occurring in border provinces was 16%, the attack rate in this region was 1.07%, five times higher than the national average of .22%. See Cólera en República Dominicana (PAHO) for more statistics.

In the Dominican Republic, a lack of numbers in the media reporting suggested a

“purposeful production of uncertainty” (Nelson 2013), where state interests lay in demonstrating the lack of cholera in the nation. As Charles Briggs has noted, “[cholera] has provided a key means of assessing the hygiene – or modernity – of individuals and populations” (2003: 268). Given the Dominican Republic’s history of defining itself in contrast to Haiti, public health crises in the western half of the island inspired a demonstration of Dominican modernity and the state’s ability to control the spread of disease. News reports highlighting the superior water infrastructure of the nation and the measures taken to insure sanitary control over Dominican territory produced statistics that assured national and international audiences alike of the modernity of the Dominican

Republic. The statistics deployed to measure cholera in the Dominican Republic were produced within the context of Haiti’s cholera statistics, numbers used to formulate meaning in a way that situated the nation in the camp of aid-donor rather than aid- receiver.

CHAPTER THREE BORDER PATHOLOGIES

The U.S.-Mexican border es una herida abierta where the Third World grates against the first and bleeds. -Gloria Anzaldúa, Borderlands/La Frontera

As medicine becomes one of the primary signifiers of inclusion or exclusion in migration politics (cf. Fassin 2012 and Farmer 1992), Gloria Anzaldúa’s famous analogy of the border as an ‘open wound’ offers a compelling perspective where narratives of the nation, identity, and health intersect and play out against the backdrop of a global political system. How could the Haitian-Dominican border be understood as a wound to the national body, a place of possible infection, and also as a breach of unity? As Anzaldúa suggests, the constant rubbing of one political and economic system against another causes this wound, and such contact exposes and reinforces inequalities that threaten to bleed into each other. Based on a long history of conflict on the island of Hispaniola, along with the ongoing projects of nation building that hinge on the construction of the most immediate ‘other,’ humanitarian constructions of Haitian ‘sufferers’ serve to further the real and imagined divide between these two nations of this Caribbean island. The border here acts as a site of vulnerability and ‘infection,’ deemed in need of intervention by the Dominican state.

In late October, 2010, as reports of cholera in Haiti surfaced, the Dominican

Republic deployed military and public health personnel to the border between these two

44 countries. The force was meant to seal the border, drawing a cordón sanitario (sanitary blockade) to keep cholera, carried by Haitian immigrants, out of the Dominican Republic.

The borderland bi-national marketplace, the main source of income and supplies for thousands of residents, was shut down amid fears of infection, resulting in protests along the border. Troops stationed along the national line blocked Haitians from crossing the border for almost a week, garnering significant media attention in the process. As the border was reopened and the market reconvened, public health infrastructures clearly indicated the hygienic prerequisites of crossing into the Dominican Republic. Sinks were set up along the border, where Haitian migrants had to wash their hands in chlorinated water in order to cross; the bi-national marketplace was removed from the center of town, relocated to an isolated edge of the border in the north; and Dominican customs regulations forbid Haitian migrants from bringing foodstuffs into the nation, undermining any potential commerce in the marketplace. This spectacle of intervention at the physical border allowed the cholera outbreaks within the Dominican Republic to be significantly played down. The assumption was that the disease has been shut out at the border gates and the Dominican Republic’s superior infrastructure and public health system wouldn’t allow for the presence of cholera in the way that Haiti’s could. Expectations of modernity and the way it manifests changed the narratives about cholera in the Dominican Republic, attributing incidents of the disease to (unlawful) breaches of the national boundary by

Haitians.

Spectacles of the State

Understandings of borders as marginal spaces in the national or even global imaginary overlook how liminality often comes to center stage in moments of crisis or emergency.

Veena Das and Deborah Poole have demonstrated how the margins constitute the spaces from which the state becomes most legible (2004). The Haitian-Dominican border offers a modification of this perspective. The Dominican state does indeed constitute a very visible presence at this national frontier, but from the Haitian side of the border we see instead of the Haitian state, the armed humanitarian intervention (MINUSTAH) reflected across the national boundary. Keeping in mind the centrality of the margins, this border brings to attention both the embodiment of the Dominican state as well as the embodiment of a system of humanitarian politics discussed above. Here, the extent to which humanitarian intervention has come to replace the Haitian state becomes visible.

With the convergence of these two systems of governance, one a coalition of NGOs and the other a state attempting to assert its modernity, health inequalities collide and seep together. The cholera outbreak on Hispaniola exposes the border as a place of pathological vulnerability, a wound as Anzaldúa suggests, imagined to be at risk for infection and breaches of national security.

In order to decipher the events unfolding and stemming from the border, it is helpful to understand the national frontier as a site of performative violence and surveillance, grounds for an everyday theatre of anxieties that have direct political and social implications. Leo Chavez (2008) has explored the US-Mexico border as a stage where spectacles play out, garnering media attention and influencing policy in the process. In exploring the show of vigilante power beginning in 2005, the Minuteman

Project in Arizona, Chavez argues that the national tensions surrounding immigration and

46 lack of security instigated these performances of power and surveillance, whereby attentions gained had the ability to force political alignments and policy changes to immigration law. Similarly, the Haitian-Dominican border as a place of strategic theatre is seeped in a history of ‘spectacular subjectivities’ that regulate behavior, identity, and law.

Historical Imaginaries of the Borderlands

In the history of the Dominican Republic, the border has served as a site of political spectacle, a region that bears the brunt of national anxieties often surrounding immigration. When leaders perceive the nation as fracturing or weakening, the border takes the limelight in national policy. As Lauren Derby has explored during the Trujillo dictatorship, “The border or skin of the body politic was perceived to be transgressive because it mixed social taxonomies, was a threat to the nation in its very liminality, and was an area as yet undomesticated by the state” (1994: 491). In a moment of economic competition with Haiti, the dictator Rafael Leonidas Trujillo, in the 1930’s and 1940’s incited a flood of borderland development, constructing roads linking the region to the capital, sponsoring light-skinned colony-communities to live there, and founding agricultural education programs to transform border residents into profitable citizens of the nation. The massacre of Haitian border residents in 1937 that propelled this campaign was initiated by Trujillo’s visit to the borderlands, where, realizing the entrenched collaboration occurring between Haitians and Dominicans, he proclaimed, “la frontera está nublada” (the border is cloudy). The violent and thorough exclusion of Haitians from

47 the Dominican Republic was institutionalized by the political elite, a group known for their anti-Haitian ideologies (cf. Sagás 2000). Discourse of health concerns and hygienic standards from this point onwards in Dominican history often legitimized this exclusion, with the three-term president and intellectual Juaquín Balaguer claiming, “A large part of the Negroes that immigrate to Santo Domingo are handicapped beings because of depressing physical defects. Few of them know of hygiene and their infiltration among the native population has brought about a decline in the sanitary indicators in our rural zones” (La isla al revés, 1983).

Crackdowns in border security and immigration reforms in more recent years further reflect this policy of exclusion. Leading up to the most recent tribunal decision to retroactively strip Haitian-descendent Dominicans of their citizenship is a long list of notable deportations. In 1981 and 1991 mass expulsions under President Balaguer coincided with political tensions, and other state-supported expulsions of Haitians from the Dominican Republic occurred in 1996, 1997, 1999 (Gregory 2007), spanning into the

2000s. During my fieldwork in May and June of 2013, truckloads carrying groups of detained and deported Haitian migrants were a common occurrence. I accompanied one human rights activist to oversee a dispute in the northern border town of Dajabón, where the family of a Haitian man who had died in the Dominican Republic was encountering problems with the Dominican border guard in bringing his body back to Haiti. In the twenty minutes we stood at the border gate, one such truckload approached the national line. The people in the truck had been collected by the military as Haitians who had migrated without documents, and they were being deported.

With the truck idling, the driver produced a document noting how many people were being taken across the border, but because the migration authorities had closed down their post and left early for the day, the paper could not be signed by the correct officials. Border guards, who have an economic interest in keeping track of how many people they deport, attempted to get a stand-in signature from the activist I had accompanied, but she refused. Unable to legally document the deportation because of the absence of migration authorities, border patrol soldiers became impatient, insisting in reference to the truck full of people, “hay que tirar ésto” (we have to dump this). A

Haitian woman bystander accusatorily pointed out that it was like they were talking about trash, not people. These daily discourses construct powerful imaginaries, where illegal migrants come to represent and are treated as a population polluting the Dominican

Republic, a group that must be removed from the body of the nation in order to uphold the standards of modernity.

This instance also illustrates the more subtle economy insinuated in the exclusion of a group from the rights of citizenship, and the dehumanization of this group in the process. Border patrol soldiers are compensated for the number of people they detain and deport, but even these transactions are difficult to document and tenuous on all sides, where migration can and does close up shop early, and where trucks loaded with Haitian migrants drop people across the border almost every day.

Manifestations of Cholera

In light of the normalized processes of deporting Haitians and the manifestations of these processes on the national line, state attempts to block cholera from entering the nation when it first emerged intersected with structures of exclusion. Discourses of disease in the Dominican Republic mapped easily onto the historically constructed narratives of hygiene and illness associated with Haitian bodies. Where preconceived ideas about chaos and disease in Haiti determined the way international press and aid agencies reacted to the outbreak there, as seen above, these same ideas determined the nature of the public health reaction in the Dominican Republic. After the immediate reaction of heightened border surveillance, narratives of public health in the media depicted order and stability, in spite of the few outbreaks of cholera that occurred within the boundaries of the nation.

Despite concerns that Dajabón, the largest northern Dominican city sharing a border with Haiti, would be impacted by the epidemic, few cases of cholera were recorded there. Instead cholera hit hardest the region around 25 kilometers east of the border, in the Dominican town of Partido. Residents of Dajabón widely agreed that no one had solid information about the outbreak in Partido. The Dominican Ministry of

Health allegedly only tested for cholera 20 of the 227 people who reported to the hospital with cholera-like symptoms. Of the 20 people tested, only seven were reported to have the disease. Patients whose illness was deemed under control were sent home; since they were not considered a threat to themselves or to others, they were not tested for cholera

(Díaz 2011; Estévez 2011). Much of the information available via the Ministry of Health or reported in the media neglects the gravity of the situation, reporting on the success of

50 state responses and a climate of control over the situation despite several critical suspected outbreaks.

As I researched the outbreak in the summer of 2013 from Dajabón proper, I was hard-pressed to hear any first-hand accounts of the disease. Any narrative about cholera on Dominican territory inevitably included a mention of Haitians, and Dominican residents were quick to recognize the Haitian migrant presence in the region. As a middle aged Dominican NGO employee explained to me in a hushed tone and with a touch of confidentiality, “Haitians… do their business wherever they want.” This man, an employee in an organization working to prevent human rights abuses against Haitian migrants and a resident of Partido, also worked as a regional director of the Dominican

Red Cross. He explained to me that the Partido outbreak in September of 2011 began after heavy rains caused flooding that infected the water tanks and the aqueduct supplying water to the town. He explained that there had been a group of Haitians living along a waterway outside of the town, but that health officials had also discovered trash and decay in the water supply, “and when it rained, the water took all that trash, dead animals, everything, into the aqueducts and into Partido.” He assured me that “as soon as the problem appeared [health officials] cleared out the tanks and everything.” Thanks to their intervention, the outbreak had only lasted fifteen days.

This commentary attests to the widespread conflations of Haitians as pollutants in narratives about cholera in the Dominican Republic. The discourse identifies two types of contagion, first the Haitians who should not be living along the waterway and second the trash that should not be in the water tanks. Much like the humanitarian responses in Haiti that targeted the hygienic practices of the population, this man’s comment about where

Haitians “do their business” pins hygienic practice on a population characterized by their nationality. As in the case documented by Briggs, where indigeneity was associated with cholera as an indicator of unsanitary citizenship, social identities and disease in the

Dominican Republic become synonymous with each other. While his commentary does nominally address the structural failures causing the outbreak, he also assures me that as soon as the problem was recognized, the state intervene to fix these failures, illustrating that such a mishap was a fluke of Dominican infrastructure, not the norm. Also missing from this interpretation of a cholera outbreak and its causes are the structures reinforcing the conditions under which Haitian migrants live in the Dominican Republic. Narratives about cholera in the Dominican Republic are both informed by and working within the context of humanitarian aid in Haiti. Interventions and narratives emphasize individual behavior as the greatest threat, and disease becomes attached to people rather than the policies and infrastructures allowing them to occur.

Sanitizing the Nation’s Gates

On Mondays and Fridays in Dajabón, thousands of Haitians and Dominicans converged at the largest bi-national border marketplace of the island. The market is the primary source of income for most of the Haitian participants, many Dominican vendors, and the town of Dajabón. It provides the largest and cheapest supply of food, clothing, and medicine for Haitian as well as Dominican residents. Before the cholera outbreak, the event took place on twelve square blocks of Dajabón’s city center. Haitian market participants would cross into town either the night before market days or early in the

52 morning to set up their stands for the event. Since the outbreak, however, the market has been moved to a kilometer north of town, where Haitian market-goers must pass through a guarded bridge across the Massacre River when the border gates are opened by migration officials each morning.

“You have to see it, in the morning when they open the doors to the border.”

Many people urged me to arrive early to the border crossing on market days to see the spectacle when I first arrived in Dajabón. Local NGO employees, European Union project directors, and regular market attendants alike insisted that I witness the moment when the gates opened, letting Haitian market-goers across the border to set up their wares on the day of the twice-weekly bi-national marketplace. “It’s crazy,” one person told me, “as soon as the gates open everyone starts running towards the market.”

The Massacre River serves as the national boundary here, a body of water named for the moments of violence that occurred here between the Spanish and French as they fought for possession of the island and between Haitians and Dominicans with the 1937

Haitian massacre. Since Dajabón enjoys a reputation as the largest and most economically significant border market town, it is also the object of a heightened security force and policing of the border. Before 2007, the town had one official crossing bridge over the river that fed into the commercial and community center of Dajabón. A new bridge, new customs building, and new market infrastructure were all underway about half a mile north of the old bridge when cholera erupted in Haiti. The new bridge is wider, better patrolled, and feeds straight into a newly constructed highway that links

Monte Cristi to Cap Haitien, two of the largest commercial towns in the northern region of the Dominican Republic and Haiti, respectively. After the outbreak, this became the

53 primary crossing site for the marketplace, an event that takes place along the Dominican banks of the Massacre River.

On one morning, I watched people gather with their merchandise along the

Haitian side of the river, waiting for the gates to open for the market. Three men struggled with a huge hose in the middle of the bridge on the Dominican side. Leaking water onto the dusty road where hundreds of people would soon pass through, the hose formed several large puddles on the bridge. The men situated the hose in the middle of the crossing, soaking the bridge and blocking the path of Haitian market-goers with standing water. While people continued to line up in anticipation of the gates opening, a migration official walked around the puddles of water that had collected with a gallon of household bleach, dumping it into the standing water and over a few equally soggy woven mats lining the sidewalk next to the railings. As the gates opened, Haitian market- goers jogged towards their stalls, having to wade through the disinfected puddles as they crossed the national line to get to the market on Dominican territory.

Household bleach, or chlorine solutions, in fact, were a common sanitation tool in the public health reactions that took place during the cholera outbreak. After a brief closure of the border in Dajabón, Dominican authorities reopened the gates and the market, moving the event further north to the site of the half-finished new market hall.

Migration and public health authorities set up portable sinks along the new bridge, requiring all Haitians crossing into the Dominican Republic to wash their hands in chlorinated water before entering the nation. While the sinks were eventually removed, the ritual of sanitation still occurs as market-goers are forced to wade through standing bleach water. Aside from the sanitized puddles Haitian market-goers pass through to get

54 to the marketplace, all vehicles coming from Haiti must stop at the Dominican migration checkpoint for their tires to be sprayed down, again with a chlorine bleach water solution.

Restaurants and cafes in Dajabón, especially those most frequented by foreign aid personnel, display their modern hygienic practices with bottles of Purell at every table.

The right to cross the border in this case has become dependent on a ritual of sanitation, much in the same way as rituals of documentation in other border crossings.

Border guards become guards of sanitary citizenship, and Haitians crossing into

Dominican Republic a spectacle. Surveillance on the national line becomes a performance meant to denote differences between citizens and ‘others’ (Chavez 2008).

Defining the standards of citizenship through the rejection of the other, Dominican state practices of regulation here use notions of ‘sanitary citizenship’ (Briggs 2003). Where

“public health officials, physicians, politicians, and the press depict some individuals and communities as possessing modern medical understandings of the body, health, and illness,” people who fail to comply with this criterion of civic belonging become

“unsanitary subjects” (Briggs 2003: 10). People insisted that I witness the flood of people crossing the border on market days, but it was the bleach-flooded bridge acting as a sanitary checkpoint that gave meaning to the spectacle, reifying the criteria of

Dominicanness and constructing the other as a group in need of sanitary intervention.

More recently, in August of 2013 the Dominican Ministry of Public Health announced the possibility of a sanitary barrier along the Haitian-Dominican border that would stop the spread of disease through people crossing the national line. Dominican

Environmental Health deputy minister Roberto Berroa claimed, “The idea is a health arc, where everyone who pass[es] through the border or port is sterilized” (Dominican Today

2013). The proposition mentions a vapor that could kill germs on the skin and in the lungs without posing a health risk, as well as a sanitizing liquid one would have to walk through, modeled explicitly after measures taken during the cholera outbreak.

The practice of using household chlorine bleach as a sanitizing agent for people crossing the border was a technique born of a public health crisis in a moment of exceptional threat. In this moment of crisis, however, we see the groundwork for more permanent changes to the practice of crossing the border. By institutionalizing the sanitary barrier and by basing this idea off tactics employed in the original reaction to cholera, we see how moments of crisis can act as opportunities for the transformation or solidification of certain hierarchies of power. As Dominican border patrol forces subject

Haitian market-goers to the sanitizing ritual of crossing the border, state power claims the rights to exclusion from the nation state based on presumptions of health and hygiene.

While Haitians are momentarily allowed to enter the Dominican Republic to participate in the marketplace, they are singled out in a publicly visible performance as ‘other,’ in need of sanitation and pegged as possible pollutants.

CONCLUSION

In the car on our way to the mountainous border town of Loma de Cabrera with several long-time residents, I was recounting the cholera outbreak in Haiti to a visiting U.S. citizen, explaining in particular the role played by MINUSTAH/Nepalese troops in the spread of the disease. One of my main informants listened patiently while I gave my interpretation of the epidemic. I finished explaining the situation, touching on the outbreak of cholera in Partido, Dominican Republic, when my informant picked up my narrative. “I have another theory,” she posited. She went on to explain how she thought

(and that other rural residents similarly theorized) that the companies doing mine exploration in the region were testing a chemical for use in extracting metals. One

Canadian owned mine happens to lie in the same place where both the Artibonite River and the river feeding into Partido begin. She suggested that these companies, in testing the land for the precious metals almost everyone assured me existed in the northern region of the island, had release chemicals into the water table that had caused cholera, or cholera-like diseases both in Haiti and in the Dominican Republic.

Conversations with border residents, including this woman, revealed a similar distrust for the few development projects being conducted along the border. With the

European Union funding projects to remodel the marketplace and repave the roads between major cities in the north of Haiti and the Dominican Republic, theories of border residents drew connections between resource extraction, international development, and

57 crises, connections that were expanded by this woman’s interpretation of cholera as a consequence of international intervention.

Dominican border residents in particular bear witness to the magnified presence of international aid organizations on the Haitian wing of the island, a presence which increasingly seeps over into Dominican territory. Anxieties of disease are also anxieties of intervention, threats to the nation’s sovereignty both as Haitian migrants continue to flow across the border to fill the need for labor, and as international aid organizations construct their objects of intervention. The narratives of national identity that the

Dominican state builds in contrast to Haiti have recently hinged on notions of health, hygiene, and modernity, but these discourses also recognize the characteristics humanitarianism has identified in Haiti that validate international intervention. As a result, constructions of the Dominican Republic as self-sufficient, healthy, and orderly strategically position the nation as the polar opposite of Haiti. While preconceived assumptions that tie racial identification to health have been formed by historic relations and tensions between these nations, humanitarian interventions on Hispaniola provide another layer to the articulation and practice of national identity in the Dominican

Republic.

As the Dominican Republic continues to witness the consequences of Haiti’s status as a ‘Republic of NGOs,’ the border provides a stage for an increasingly urgent performance of the perceived antithesis of Haiti. Borrowing from the technologies of health intervention that aid organizations used in Haiti, the Dominican Republic reacted to the public health crisis with performances of difference based on sanitary citizenship.

These performances contributed to a national narrative highlighting health, sovereignty,

58 and order. While such discourses of national identity are meant to define and unite the body politic based on particular characteristics, they also speak to international audiences, claiming sovereignty in a way that interprets and reacts to a growing humanitarian impulse, one gathering momentum in the logic of global order.

During my field research, my constant inquiries about cholera at the border prompted one long-time resident to offer a broader perspective: “Él que vive en la frontera es un héroe. Todo se le pega; cólera, malaria, hasta balas.” He who lives on the border is a hero. Everything hits him, or everything sticks to him; cholera, malaria, even bullets. To live on the frontier between Haiti and the Dominican Republic, as this man points out, is to live in a perpetual crossfire, where struggles of the state become struggles of health intervention, and where border communities get caught in the battles. While cholera did change the way the Dominican state conducts surveillance a the national line, for border residents who often find themselves at the epicenter of public health interventions, the outbreak and reactions to it were less shocking. Cholera provided another opportunity for the state to assign meaning to anxieties about disease, immigration, and modernity. Those who live at the border inhabit a space where modernity is perpetually contested, defined, and tested.

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Biography

Kyrstin Mallon Andrews is an M.A. candidate in Anthropology at Tulane

University. She has spent most of her life in Seattle, Washington, where she graduated from the Jackson School of International Studies at the University of Washington with a

B.A. in Latin American Studies. Her interest in borderlands stems first and foremost from an admiration for the people who traverse them, both physically and intellectually.

Coming of age in a generation inundated with a culture of giving, donating, volunteering, and serving on a global scale, Kyrstin’s work is driven by a questioning of how and why this culture of global aid came about. While this thesis reflects the author’s dedication to peripheral places as global stages, the scope of this work extends beyond the Caribbean, seeking to address the discourses and logic that drive the actions of her peers and herself.