Health in the Highlands

While some of the world's population isolated to prevent COVID-19 from spreading, others were unable or unwilling to do so. Governments and international bodies made mercurial recommendations and sometimes laid down harsh mandates that were out of step with people's conditions of life. Only the most guileful would fail to acknowledge how race, ethnicity, class, region, age, sexuality, and gender shaped how one lived through or died with COVID. This well-researched book by David Carey Jr. is about the structural inequalities that affected health for Indigenous Guatemalans and Ecuadoreans in the early twentieth century. It is fitting that long sections of the book (including a cogent foreword by Jeremy A. Greene) discuss the pandemic.Carey's argument can be summed up as follows. Medicine not only reflected but also reinforced, shaped, and was shaped by racism, sexism, and classism. Yet through contact, conflict, and collaboration, Indigenous Guatemalans and Ecuadoreans influenced modern medicine. Public health expanded state power but also sometimes offered “opportunities [for Indigenous peoples] to deflect state overtures and advance their healing practices and knowledge” (p. 213). Drawing on Steven Palmer, Carey argues that “hybrid healthcare and syncretic medical discourse” developed as “some officials advanced vernacular medicine that incorporated scientific and traditional knowledge” (pp. 213–14). Traditional knowledge continued to evolve in response to community needs and state regulation. For their part, health officials were often driven by pragmatism and awareness of their own limitations. Some access to health care, even if by unlicensed practitioners, was often better than none at all. One comes away from this study with the understanding that who medicine was about was not necessarily who medicine was for.This book engages several familiar areas of study within the new history of medicine—namely, histories of biomedical epistemologies (here Kichwa, Maya, and others), state-focused histories of public health, and sociocultural histories of disease. This breadth gives the book a wide range of interlocutors, although it is most readily in conversation with Palmer, Marcos Cueto, Julia Rodriguez, A. Kim Clark, Ann Zulawski, Julyan Peard, and Anne-Emanuelle Birn. Carey also engages beyond the region with Beatrix Hoffman, Randall Packard, and Warwick Anderson.Health in the Highlands is organized into thematic chapters. The introduction offers an overview of late nineteenth- and early twentieth-century Ecuador and Guatemala and explains some key figures (e.g., curanderos, comadronas, the Rockefeller Foundation). It also lays out Carey's transnational and comparative methodology. Chapters address Kichwa, Maya, and Rockefeller Foundation approaches to health and disease; the persecution of Indigenous healers; reproductive health care, from traditional midwifery to obstetrics and hybrid approaches; racism in public health projects; typhus and typhoid; and malaria. A wealth of examples, extensive footnotes, and a broad bibliography make this book invaluable for researchers as well as graduate and advanced undergraduate students in the history of medicine. It is also readable and jargon-free. It honors Indigenous resistance and acknowledges accommodation. The author's decades of experience with oral history are reflected in his thoughtful analysis.The book's transnational and comparative methodology is meant to expose “connections between imperialism, public health, state and non-state actors, and constructions of race and racism” (p. 4). In general, however, transnational exchanges recede after the introduction in favor of comparisons that usually position Ecuador as ahead of or better than Guatemala in its treatment of Indigenous citizens. In Carey's analysis, the reasons for this difference are complex, from labor relationships to the whims of powerful politicians and regional ecologies. But at times, these complexities are reduced in favor of highlighting difference between the two case studies. For instance, Carey draws a distinction between national eugenics (in Ecuador) and racial eugenics (in Guatemala) whose contours and significance could be clearer.Such a rich and wide-ranging text necessarily leaves some stones unturned. Discussion of how Indigenous groups differed in their approaches to healing or understandings of illness would have been fascinating and would have interrupted an Indigenous/non-Indigenous binary that sometimes shades the text. More could have been made of the stunning point that Rockefeller Foundation officials in Ecuador rarely encountered Indigenous people. Some readers might be curious to know more about exchanges between anthropologists and public health officials at a time when anthropology was working to create taxonomies of Indigenous peoples. Were Kichwa and Maya people compared? If so, how did health metrics shape that comparison? A passing reference to the German pharmaceutical company Bayer suggests a fascinating avenue of research into the role of commercial actors in public health. Likewise, Dr. Hernán Martínez Sobral's media-rich typhus eradication campaign, with cinematography and posters, calls for further study. Future comparative work on, say, Peru, Mexico, Panama, Colombia, or Venezuela can help tease out the distinctiveness of Guatemala and Ecuador. Carey's book is the best kind of historical research—it stirs curiosity in the reader and is certain to spur new histories of Indigenous medicine

Alternative medicine · Biology · Ethnology · Geography · Indigenous · Pathology · Sociology · Traditional medicine · Anthropology · Ecology · History · Medicine · Public Health and Social Inequalities