An unexpectedly rich source has been one popular science writer, Robert S. Desowitz. As Donohoe (2012) notes: "Literature, medicine, and public health share a fundamental concern with the human condition. Through literature, readers can vicariously experience new situations, explore diverse philosophies, and develop empathy with and respect for others whose place in society may be very different from their own". This reader placement is true of the writing by Desowitz (1926-2008) who through his books brings to life tales of tropical diseases. He has been described as: "A veritable Sherlock Holmes of parasites and pathogen" reflecting the intrigue, a fast pace and curiosity of his works (Desowitz, 1991). Tropical medicine is viewed through a portrayal of the scientists involved and policy ideas employed. While his writings did not win a major award nor were they sell-out successes, he was praised for his writing style23 and the topics he brought to life in the science writing community, (including a highly commended prize from The Medical Writers Group24 and supportive reviews from the New York Times).
Of course there are limitations of using a single-authored resource and it is used in conjunction with a wide variety of other sources, outlined earlier. I also must acknowledge the particular
21 Horizon films relevant to NTDs (The TVDB, http://thetvdb.com, Accessed 2/4/14) are: The New Face of Leprosy (1986); Mosquito! (1998); Malaria: Defeating the Curse (2005); and Guide to a Pandemic (2009)
22Influential films on NTDs have included: Chagas: A Silent Killer, 2005, Ricardo Preve for Al Jezeera (said to be influential to Argentinian footballer Lionel Messi who then did another documentary); Malaria:
Fever Wars (2005) by PBS; The virus hunters (2007) by Steven Jones, WHO; Yoro, the empty granary, (1995) by WHO; and the Compassionate exile (1999) by Bob Madey and Larry Thomas.
23 A quote by two of Desowitz's mentees sums up his writing style: "Bob’s rich anecdotes that tropical medicine was a noble discipline of vast importance to human health and also an adventure involving outsized or odd personalities, hilarious incidents, and great failures and successes" (Miller & Duffy, 2008).
Another reviewer said of his books: “the life complexities of the microbial agents of disease are more than matched by that of human behaviour” (Wilkinson, 2004).
24 The Medical Writers Group or the book prize was given for 'Federal Bodysnatchers and the New Guinea Virus' (2004) (Wilkinson, 2004).
lens that he looks through. While culturally sensitive and having spent years in the field, Desowitz is from the US and identifies with an American outlook. For example, at one point he asks why the Mexicans were not grateful for being relieved of yellow fever and speaks from and to an American perspective when reluctantly conceded: "We see only ingratitude where we should, instead, have empathy for the hurt national pride of the beneficiary countries, which may also have antipathy for the donor countries that they too often perceive as economic and political aggressors" (Desowitz, 1991, p. 174). 25 He is not a trained anthropologist, historian or social scientist, he is a doctor and epidemiologist first and foremost.
However, it is also worth highlighting the benefits in exploring one perspective of how tropical disease is communicated to a public and lay audience, which he does exceptionally clearly as a medical specialist. Like other doctors who have written medical histories he is interested in the doctors or scientists and their stories of scientific discovery but does also engage to an extent in the policy and politics of disease. His books spanned the 1980s to early 2000s and he was able to capture the changing story of tropical disease. Desowitz was not active in writing when these diseases made their final iteration as NTDs (and indeed it would have been interesting to see his perspective on them). He had already charted a vividly descriptive evolution of tropical medicine, encapsulated in six books.26 The book series was compiled from field stories, interviews and many years of experience in tropical medicine as an epidemiologist, official at the WHO and academic, with a career spanning over 60 years, the last 20 of which he spent producing popular science works. These books are shown below in table 4.
Date Title
Federal Body Snatchers & the New Guinea Virus: Tales of Parasites, People & Politics Table 4 Books by Robert Desowitz shown by date
It is the title of his last book that sums up most tidily his contribution in: 'Parasites, People and Politics'. His focus of interest lay in parasites, the people they inhabit, the pursuit of cures and the political treatment that pursuit involves. 'Malaria Capers' was most probably his most famous book, shown through the media coverage at the time. It is his most journalistic and also
25The critique of the Rockefeller Foundation as a cultural imperialist is also overlooked, in underlying:
"...cultural imposition of American culture and values abroad; favouring elitism rather than equity;
ideologically trying to vindicate capitalism; and investing in health to make the tropics safe for commerce"
(Chen, 2014, p. 718).
26 Desowitz began writing for the public in 1976 writing for the public with an article for the Natural History Magazine (Miller & Duffy, 2008). The article was entitled 'How the wise men brought malaria to Africa' and sparked a life-long interest in popular science writing.
his most critical with the second half of the book dedicated to exposing corruption in malaria research, most specifically the illegal mishandling and misuse of USAID funding by scientists (and an administrator). In his other writings this policy gaze was also evident when he took on patents in 'Federal Body Snatchers and in the New Guinea Virus: Tales of Parasites, People and Politics'. Insights taken from Desowitz's body of work will be referred to throughout this thesis.
Desowitz also undertook a self-reflection of his own involvement with tropical diseases. When he began his career in the 1950s he was told: “Malaria is about to be totally eradicated, and you will never make a career, let alone a living, from it” (Desowitz, 1987, p. 12). The supposed near eradication of malaria was why he switched to trypanosomiasis research but “(B)y the 1970s, malaria was more of a threat than ever, at the expense of interest in the trypanosomiases”
(Wilkinson, 2004). Such a snippet is emblematic of a group of diseases that are closely connected to the promise of eradication, to varying degrees, where at least the possibility often appears in near sight. It is a constant movement for which diseases require attention. The quote extends to Desowitz's very premise about the category of tropical disease in challenging preconceived ideas: "Well, these diseases that we call "typically tropical" have been as American as the heart attack" (Killheffer, 1997). He held a deeply informed and open outlook on these diseases in time and space. As well as touching upon the related politics of science and medical practice, he was aware of the effect the term had on how the diseases were viewed.
Terminology forms a topic that I am concerned with throughout this thesis. My disciplinary background in development economics has led me to have a preference for the terms 'developing' and 'developed'. I also see the disciplinary preference in STS to use 'global north' and 'global south', which I do use occasionally but my contention is that these terms send across a false geographic message, even if implicitly, in an imagined or constructed south and north. 'The West' as ideological positioning and political hegemony is a term I use occasionally.
Tariq Khokhar a data editor at the World Bank and colleague economist-statistician Umar Serajuddin reflected on the use of the terms at their institution:
"Humans, by their nature, categorize. Economists are no different. For many years, the World Bank has produced and used income classifications to group countries. The low, lower-middle, upper-middle and high income groups are each associated with an annually updated threshold level of Gross National Income (GNI) per-capita, and the low and middle income groups taken together are referred to in the World Bank (and elsewhere) as the “developing world.” This term is used in our publications (such as the World Development Indicators and the Global
Monitoring Report) and we also publish aggregate estimates for important indicators like poverty rates for both developing countries as a group and for the whole world. But the terms
“developing world” and “developing country” are tricky: even we use them cautiously, trying to make it clear that we're not judging the development status of any country" (2015).
This is an interesting consideration of terms, especially as some scholars, such as William Easterly charge that the World Bank means something 'lesser' in referring to ‘the Third World' or 'less-developed countries’ as places devoid of "liberty, freedom, equality, rights, or democracy"
(2014, p. 5). Easterly believed this characterization of countries is shown by the limited role these concepts play in their reports, a linguistic omission to avoid the consideration of government in development. He had the following extraordinary response when querying:
"Questioned about the remarkably consistent omission of the word democracy from World Bank official reports and speeches, for example, the World Bank Press Office explained to this author that the World Bank is legally not allowed by its own charter to use the word democracy" (ibid.).
Economist Branko Milanović similarly talks of how the World Bank has preferred not to use the word inequality but the 'watered down' version 'inequity' (see his 2011 book 'The haves and the have-nots') instead, looking for more technical rather than political reasons for poverty: "Every study on inequality, of course, challenges the structures not only of the economy but also of the world we live in, and these questions are not always welcome... it was very, very difficult to get any type of grants for research on inequality..." (Milanović, 2016).
There are evidently problems in using the terms 'developing' and 'developed', not least the question of when does development happen, when does development stop and where is all of this development leading to? It immediately gives the impression that certain countries are done, they have achieved an ahistorical state, while others lag behind, they are lesser, always catching up and always sub-par. At the time of my training 'developing' and 'developed' were deemed better than using 'First world' and 'Third world', which were seen as particularly derogatory. Also commonly used were high-income, middle-income, and low-income. These are more neutral in some ways, although have the drawback of being three groups, that can begin to get messy, especially as more subcategories are used such as 'higher middle income' and 'lower middle income'. I also think that the perceived neutrality of these terms is a misnomer because there remains of politics of categorization, in why some countries belong to one group and some to the other – it is an organization that cannot be done in an objective way.
I have even less preference for the terms 'highly industrialized' and 'unindustrialized' as it is very difficult to say where the cut off is and it sounds especially old fashioned to claim that countries need to have an industrial revolution to develop. To me 'developed' and 'developing' accepts that we have perceptions of some countries being in one group and others in another, dependent on country types, their histories, when they have 'developed', their relationship with other countries, and their aspirations for the future. It is not perfect but they are the terms I find
most agreeable and as long as limitations are acknowledged, especially in providing detail, contradictions, and tracking changing circumstances, they serve an adequate function in this thesis.
The dividing lines and distinctions run deep in understandings between the 'developed', 'global north', 'the West', 'industrialized', 'high-income' and 'the rest', 'subaltern' (in reference to colonial relations) or the 'other'. The status is of inside or outside, with other terms such as the 'centre' and the 'periphery' demarcating that there is somewhere that countries want to be and somewhere else, where they want to move away from. Anthropologists have often considered this positioning between one and another. The ethnographic 'other' according to Rapport and Overing has been the anthropological object, "...reified, homogenized and exoticized" but as objects they are silenced (2000, p. 98). The 'other' has "negative properties in Western thought, for they cannot speak, think, or know" and these descriptions apply to people or peoples, but could very well be applied to countries as well (ibid. p. 99).
One of the central dividing lines, apart from wealth and industry, is science27 and the epistemological privilege it provides: "...the idea of the superiority of Western culture, particularly its spectacular scientific success, became the potent and decidedly unliberal yardstick through which anthropologists assessed the accomplishments of other cultures" (ibid.). The very analytical categories that we use such as scientific and unscientific, cause unhelpful binaries and ignorance to cultural relativism, as "...the other's local was to be understood within the context of our local, which in the end became a universal standard, not only of judgment, but for description as well" (ibid., pp. 99 - 100). These are important methodological considerations in the use of terminologies and distinction made with the 'other', to take forward throughout the rest of this thesis.