Chapter Two has examined the social history of global health and its interventions for malaria from the early nineteenth century to the early twenty-first century. Given a
connection between colonial medicine and tropical medicine, I further explored how colonial administrations viewed ‘exotic’ illnesses and afflicted bodies of the local natives in many parts of the tropical environment in Asia and Africa. The colonial notions of the local body as disease agents, and racial hygienic perceptions were associated with imperialism and expansionism of colonial medicine. The colonial gaze on sick bodies was imbued with the European-centered cultural concepts of race, ethnicity, class, and gender. The shift from the racial and moral blame on the exotic natives in the tropics to the germ theory between the late nineteenth century and early twentieth century was a hallmark in international public health history. When science advancement found germs as the disease agents, such cultural explanations and environmental determinism were replaced by the microorganism theory and laboratory work. As such, tropical medicine played a role in associating various infectious diseases to the ‘tropics’ environment and sick natives came to be viewed as victims of the disease agents, not causing their illness due to poor morals.
However, the germ theory of tropical medicine lacked explanations of social, and political economic factors that were often ignored as a cause of the local people’s suffering. Even after the dawn of tropical medicine, the colonial legacy in health interventions by the Western countries and organizations had long impacted the ways in which the local
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example is that international health interventions often took an aggressive technology- centered approach, and often ignored the local people’s social needs and the cultural
complexity that existed in the local context. In sum, although the advancement of science and technology, especially in medical fields, significantly contributed to reduce mortality and morbidity of some deadly infectious diseases, tropical medicine was able to provide its technologies by engineering ‘the tropics’ as a natural laboratory and its peoples as their research subjects.
The history of nearly two centuries of malaria efforts have strong connections with the history of the World Health Organization (WHO) and global health development. At the turning of the twentieth century, there was virtually no collaboration across nations although governments and some organizations in wealthy countries had launched malaria and other infectious disease control initiatives. The establishment of the WHO as the international public health organization after the Second World War brought hope in international societies for the eradication of some infectious diseases, such as malaria and smallpox, by engineering modern medical science and technologies. The WHO’s malaria program goals shifted from eradication to control, then elimination.
From the 1950s through the 60s, malaria interventions were closely related to the advancement in science and technology in the environment of international cold-war politics and competition in science advancement among them. Thus, chloroquine and DDT spray were often used for political purposes to gain political alliances. The lack of leadership by the WHO and the lack of funding contributed to the increase of malaria burden in developing countries in the 1970s and 1980s. The structural adjustment programs (SAPS) brought neoliberal and market-oriented health interventions, including infectious disease control
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programs, and many poor countries, especially sub-Saharan countries, had to cut their public health budgets.
Although it is still too early to say, the WHO and many of its partners agree that the global health malaria control efforts might have reached their peak at the beginning of twenty-first century, and now is the best time in terms of funding resources, diversity in partnerships, and strong leadership and commitment by the global health players. The expectation for the elimination of the disease from the world’s populations have been ushered in by the strong belief in science and technology in the biomedical field. The scale- up programs by international governments, also created more job opportunities to the local populations in health sectors at the public and private sectors.
However, what is lacking in this glamorously painted global health discourse of the history of malaria control and on the current successful achievement in reducing mortality and morbidity, is that there are not many critical investigations of the local peoples’ experiences of such global health interventions at the local clinical settings, and how these interventions have impacted their understandings of the disease, biomedical interventions, within other social, cultural, and political economic contexts. Because illness is experienced by people within a local context, investigation of such aspects will add a more critical, human-centered approach to global health.
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CHAPTER THREE
THE KAREN IN THE THAI-BURMA BORDERLAND
This chapter has two objectives. First is to discuss the social history of the Karen in Burma, and the Thai-Burma borderland as a space of humanitarian interventions as well as a space of disease surveillance Second is to provide a social history of the Karen in the Thai- Burma borderland, who have not been studied sufficiently in anthropological studies. By discussing these two aspects, I analyze how state power and humanitarianism emerge in the borderland, and at the same time, how local and international influences situate
undocumented Karen migrants in the contested Thai-Burma borderland. My analysis in this chapter presents the cultural politics of ethnicity, citizenship, and epidemics of the borderland in four sections.
First, I present an ethnographic sketch of a border town, Mae Sot, which is called “Little Burma” in northwestern Thailand. I present the border town because the border town has long been accommodating various ethnic groups both from Thailand and Burma beyond its national boundary. In the Tak Province where Mae Sot is located, ethnic minority peoples made up about eleven percent of the population of the province according to a survey data from the late 1960s, and among those the majority of the ethnic minority was the Karen (Kunstadter 1983:18).43 In recent years, the town has come to be known as a crossroads of
humanitarian aid projects for migrant populations as well as surveillance sites for malaria epidemics, due to migrant populations and the emergence of multidrug resistant malaria. I claim that Mae Sot shows an example of contested border politics in the Thai-Burma borderland. Mae Sot and the Thai-Burma borderland not only receives attention from
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humanitarian perspectives, but also epidemiological interests and cultural politics of the citizenship and ethnicity.
Second, I briefly examine ethnographic accounts of the Karen people. I review previous ethnographies of the Karen both in Thailand and Burma in order to stress that there are different political and cultural representations of the Karen ethnic group of peoples in both countries. Previous studies of the Karen often tend to discuss either within the context of Thailand or Burma, and address that these differences stem from the cultural politics of the nation-state and their social relations with nation-states they reside. My research does not ignore these previous studies of the Karen, and agrees that understandings of the social and political situations of the Karen in the borderlands needs careful investigations of the historical accounts of the Karen in both countries.
Third, I examine the social history of the Karen to elucidate their long-term suffering from ethnic conflict in Burma, and how the historical relationships between the Karen and western missionaries, the British, and Burmese governments is connected to this current ethnography of the people in the borderland. The social history of the Karen in Burma is important to understand why the Karen endure inequality in health access and violence in their everyday life. The political economic conditions of the Karen provide insights into an understanding of the global health humanitarian effort to reach out to internationally displaced populations (IDPs), including undocumented migrants and refugees in the borderland, and malaria burden in the locales.
Fourth, I conclude this chapter with my analysis of the Karen as undocumented migrants in the humanitarian aid, and the global health attention to their social and biological space, as it coincides with one of the epicenters of multidrug resistance, which I described
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more in detail in Chapter One and Two. I analyze the discourses of undocumented migrants among the Thai people and epidemiologists who work in the borderland. I argue that health access among the Karen in the borderland is inflicted, despite the humanitarian aid activities along the border.