Epidemic!
Alternative treatments for global ailments
Pranjal Tiwari and Danee Voorhees
It has been a bizarre experience living in Hong Kong amid the current
outbreak of Severe Acute Respiratory Syndrome (SARS) that began earlier
this year and observing some of the trends that have taken place.
We seem to have become a panicked and confused city with foreign
nationals leaving en masse, sensationalist news coverage filled with
incongruous information, and streets crowded with mask wearers and
sellers. Normal life has been profoundly interrupted. People have
been advised to stay home as much as possible; schools have been
closed for nearly a month; restaurants and hotels have seen business
down by 80 to 90 percent.
It’s not that SARS is nothing to worry about — it is,
after all a new disease and has affected well over 1,000 people in
the city — but in our current social and economic organization,
responses to infectious disease outbreaks, like reactions to other
emergencies, can serve to reinforce the oppressive hierarchies and
structures of power that dominate our societies.
Perhaps that’s not such a groundbreaking observation on its
own, but in imagining a better world, one of the most difficult considerations
seems to be how participatory societies could react to an emergency
like SARS without creating or reinforcing such oppressive hierarchies/structures
and fundamentally compromising their norms.
Cover-Ups and Gloss-Overs
The role of oppressive institutions has been evident in Hong Kong.
From the start of the outbreak, the government’s reaction has
been with the interests of business elites firmly in mind. Initially,
the details of the disease and extent of the outbreak were covered
up by the government which feared affecting investment and explicitly
stated its uneasiness about affecting the city’s massive tourism
industry. It was recently revealed, for example, that the public
list of SARS patients did not include the name of a high profile
expatriate businessman who had contracted the disease. When the government
was finally pressured to release the information, one of the victim’s
colleagues remarked: “They have taken a week to own up to the
fact that SARS is also affecting wealthy people who live in the top
end of town.”
As it became clear that this cover-up was ineffective, that keeping
quiet about SARS was actually achieving little in preventing fears
among privileged classes — reflected in sluggish markets, a
general slump in economic activity, and massive flight of foreigners — government
actors turned instead to a rhetoric of aggressive reassurance.
James Tien, Chairman of the Liberal Party described the situation
as “a war against an unseen enemy, and one we must not lose.” (Where
have we heard that before?) It was also revealed to the public that
the government’s War Council would strategize against this
enemy in their “purpose-built bunker in the basement of the
Central Government Offices if an emergency were declared.” Most
recently, Betty Tung, the wife of Chief Executive Tung Chee Hwa,
launched a symbolic clean-up program called Operation Unite, sponsored
by local business elites (or community leaders as they call themselves),
through which an army of 10,000 volunteers would disinfect public
housing estates and dirty streets. The tangible anti-viral effects
of such moves are, of course, questionable at best. The military
vocabulary and tough talking action plans are aimed more at securing
support and faith in the power of the state in a time of emergency.
I’m sure the dangers of such a public relations boost for
oppressive hierarchies are fairly evident but to look at one specific
example, James Tien, quoted above as battling against an “unseen
enemy,” is himself known as an enemy of the poor to migrant
workers’ groups, having recently successfully concluded a campaign
for a tax targeted specifically at the wages of Hong Kong’s
foreign domestic helpers. The current emergency is an opportunity
to gloss this over, for Tien to project himself as a strong community
leader in an embattled and confused city.
Moreover, the advice of medical experts, when mixed with a rhetoric
of fear, has led to a general level of distrust in the city. “People
aren’t wearing masks to keep their own germs to themselves,” says
Klaudia Kong, a 28-year-old Hong Kong resident who refuses to wear
a face mask. “They’re wearing them because they don’t
trust anybody else.”
SARS and the National Security State
A similar situation can been seen internationally. Indeed, if James
Tien is employing rhetoric reminiscent of the war on terrorism in
Hong Kong, we can only imagine what kind of language has been used
in the US to talk about this disease.
The SARS outbreak in the US seems to have been used to further justify
the emerging national security state, fed by the spectre of bioterrorism.
SARS was recently added to the list of diseases for which the Center
for Disease Control has the power of forcible quarantine, an authority
that was originally demanded by Secretary for Health and Human Services
Tommy Thomson in 2001 in the event of a biological warfare attack.
Aside from the public relations value of such a move, the goal of
expanding an avenue of domestic state power was also achieved as
National Guard units would be used to enforce the CDC’s authority.
For the Bush regime, it seems to have been easy to exploit both
the emergence of SARS and the position of the CDC as specialists
to further the current agenda of expanding domestic repression. As
Senator Max Cleland recently said, Congressmen “realize the
CDC is a national security agency now.” Like other national
security agencies, the CDC saw an expansion of its funding in the
current climate of fear with its 2002 budget jumping to around $4.4
million. “We would have limped along, business as usual,” Cleland
said. “Now, four weeks later, we’ve got a record budget
passed.”
The main means by which information from medical experts is relayed
to the public, media reporting of SARS in the US has been laden with
fear and hysteria. In one incident on April 1, US TV networks interrupted
their coverage of the Iraq invasion to bring viewers live footage
of an American Airlines flight from Tokyo that had just touched down
at San Jose, California. The cabin crew feared that five people aboard
might be showing symptoms of SARS - the basis for the alert, it turned
out, was that the passengers had simply coughed.
The Hysteria Virus
At a recent telebriefing held by the CDC, several frightening questions
were posed by journalists. Some questions asked whether SARS was
a “fire drill for bioterrorism,” incorrectly equating
disease outbreak with a terrorist attack. Several other journalists
played up the role of SARS as an external threat, one question being
whether airlines have “routinely allowed obviously sick passengers
to board international flights bound for the United States, and that
Customs officials sometimes let them into the country.” This
question is asking whether US officials are routinely allowing an
external threat to enter by being soft on the issue of borders, a
theme that has become routine whether the media is discussing illegal
immigrants from Mexico or Arab terrorists. Such discussions have
already helped to further elements of the Bush agenda — the
proposed budget for the Border Patrol, for example, saw an increase
of US$2.2 billion this year.
Another journalist actually made an explicit link between SARS and
non-white populations in the US: “Among the 115 U.S. cases
how many of those occur within the Asian population, and is there
a greater risk of encountering SARS within a Chinatown of a U.S.
major city?” she asked. The equation of SARS and Asians, like
the linking of SARS and terrorism, is a logical fallacy — an
improper use of the and function — but the scapegoating of
foreigners in Chinatown for spreading disease is an easily believed
sensationalism. “You’ve never seen so many ‘For
Lease’ signs in Chinatown,” said David Lee of the Chinese-American
Voters Education Committee in San Francisco, commenting to the San
Jose Mercury News on the decline of many Chinatown businesses.
Businessmen in Central Park West could be carrying SARS after returning
from trips to Worst Affected Areas. However, this view is met with
considerably less hype and hysteria, even though the disease is said
to have travelled to over 20 countries via air travel. In fact, cases
of SARS in Vietnam, the Philippines, and Singapore were originally
traced to an infected businessman who travelled to each of these
places before dying … perhaps an interesting side effect of
global capitalism?
Capitalist globalization has certainly been a theme running through
the reporting of the business press and elite newspapers in the US
and internationally on this issue. Many have mutated the disease
to fit the agenda of China-bashing. Such editorials have generally
turned viable arguments about the Chinese government’s “lack
of transparency” in handling the SARS crisis into support for
the country’s continuing history of increasing transparency
for foreign investment and neoliberal trade regimes. A recent opinion
piece in the South China Morning Post, for example, noted that “China’s
hopes of being accepted as one of the world’s leading nations
has suffered a setback … for China to join the modern world,
it will have to … embrace concepts of openness not only regarding
trade rules, but in other spheres as well.”
Reporting in Hong Kong itself has also been full of sensationalism,
which Tim Yan Lim, ex-Chairperson of the Hong Kong Journalists’ Association,
says is nothing new to journalism around the world. “Given
the market structure, we can expect sensationalism for some time,” he
said. Crises sell.
Another Approach to Health
Like most people in the city, I have been avoiding crowds, wearing
a face mask, and regularly washing my hands, trying to do what I
can to avoid infection. I realize that there is little choice but
to act responsibly and take the advice of medical experts.
I don’t think this is necessarily a bad thing. During an infectious
disease outbreak, it makes sense to pay reasonable attention to the
group carrying out research into the disease and its cure. On an
abstract level, this is a dependence based on trust, the hope that
an informed group is looking after our interests and working to prevent
millions from dying.
The problem comes with moving from the abstract to our present system
of social and economic organization and seeing how this dependence
can be exploited by power. Medical experts and health departments — like
all institutions — are today closely linked to oppressive structures.
These hierarchies end up being indirectly but crucially supported
when we feel the very real need to take the advice of specialists
and experts in an emergency situation.
How can we change this? In a more agreeable society, we could say
that these hierarchies would not exist. A more localized medical
system, for example, would allow us to take health-related advice
without it being filtered through oppressive institutions. Moreover,
changing fundamental aspects of modern capitalist life and social
relations would have a profound effect on our immune systems, says
Greg Nigh, a physician and activist in Portland, Oregon.
“I would suggest to you that the progressive decline of immune
competence in industrial societies is precisely because of the products
of capitalist production that have invaded our bodies and their living
spaces. … Our bodies are filled with chemicals … our
lives are filled with stress: work, financial, body image, relationship,
etc. In short, we are creating a world in which simply living is
immunosuppressive.”
But it does not seem enough to simply say that social relations
would be different in the future. Nigh explains that responses to
an infectious disease epidemic would have to come out of a more participatory
medical system, one that is more democratic in terms of its overall
approach to the concept of health.
“In a participatory community, I believe that the actual practice
of medicine looks very different. The system doesn’t simply
treat disease. For example, in any sensible system, the health care
system is integrated with the food production system, because health
and food are two sides of the same coin.
“Conventional medicine is not to be thrown out. Not at all.
MRIs and CT scans and other technologies are still important, but
imagine a health care system that people actually wanted to use,
a system that we looked forward to using, a system that left us feeling
more vital after an encounter with it.” He goes on to suggest
that, in such a community, care is local, personal. It is not simply
a system that gives us a product and sends us on our way.
Specifically referring to an outbreak of infectious disease, supportive
care would take on a much more active role. This would involve “therapies
that enhance the body’s ability to fight infection, not therapies
that compromise that ability.” For those whose life is at risk,
more invasive procedures may be necessary.
Such a response may be near impossible to imagine within today’s
health care industry — particularly in Hong Kong during these
times.
But perhaps it is because the alternatives are so difficult to imagine
that the issues of popular health and effective responses to health
crises should be central to movements organizing towards wider social
change. |