A less modest witness: Collective advocacy and motivated truth in a medical humanitarian movement
PETER REDFIELD
In this article, I examine the evolving tradition of témoignage (witnessing) maintained by the international humanitarian organization Médecins Sans Frontières—Doctors Without Borders. Comparing this practice to traditions of virtuous testimony by the public intellectual and the gentleman scientist, I suggest that collective actors like nongovernmental organizations now play a central role in defining secular moral truth for an international audience. By integrating medical expertise and public expression, the work of this group illustrates an overtly motivated form of scientific research, finding facts in the name of values, in the pursuit of both technical and ethical ends.
[witnessing, nongovernmental organizations, intellectuals, expertise, anthropology of science, medical humanitarianism, Médecins Sans Frontières]
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Review essay: Poverty, marginality, and illness
VEENA DAS

Stories in the Time of Cholera: Racial Profiling during a Medical Nightmare. Charles L. Briggs with Clara Mantini-Briggs. Berkeley: University of California Press, 2003. xxvi + 430 pp., illustrations, maps, tables, notes, bibliography, index.

Pathologies of Power: Health, Human Rights, and the New War on the Poor. Paul Farmer. Berkeley: University of California Press, 2003. xxiv + 402 pp.

In this essay, I review two recent books in the field of health and disease—one dealing with an epidemic and the other with the consequences of structural violence on morbidity and mortality among the poor. Both books are excellent demonstrations of how the alliance between global institutions, the state, and medicine (esp. public health) leads to discrimination on the basis of race and class. Arguing outward from the books, I ask whether new diseases replicate earlier fault lines or whether new kinds of discrimination come into being as other technical and social imaginaries of danger to the social body are generated. I raise some puzzles within the global TB scenario and discuss the appropriateness or lack thereof of analyses based on economic and public-health models. br> [cholera, epidemics, poverty, race, structural violence, tuberculosis]
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Where ethics and politics meet: The violence of humanitarianism in France
MIRIAM TICKTIN
I examine the role of humanitarianism and compassion in an emergent ethical configuration that makes illness a primary means by which undocumented immigrants obtain legal residency (“papers”) in France. I argue that the sacred place of biological integrity in this ethical discourse leads immigrants to trade in biological integrity for political recognition. I demonstrate first how humanitarianism has been transformed into a form of politics, functioning as a transnational system of governance tied to capital and labor even while purporting to be apolitical. I focus in the second half of the article on the consequences of humanitarianism as politics, which include new biopolitical practices, unexpected diseased and disabled citizens, and a limited version of what it means to be human.
[medical humanitarianism, human rights, France, anthropology of ethics, biopolitics, immigration, citizenship]
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Valuing Life, Weighing Death

Beyond suspicion: Evidence, (un)certainty, and tuberculosis in Georgian prisons
ERIN KOCH
In this article, I address relations between tuberculosis and incarceration in postsocialist Georgia. I focus on the traffic in sputum samples among prisoners for whom a positive diagnosis promises a transfer to the TB prison colony, where living conditions are better. I argue that the practices associated with this exchange, called “cheating” by medical program administrators, and responses to them shed light on the unintended consequences of biomedical standardization and the ambivalences and ambiguities of disease governance in contemporary Georgia and the post-Soviet context, more generally. Cheating is a moral–diagnostic category: Trafficking in sputum is a form of constrained agency in which disease becomes a survival strategy.
[Georgia, tuberculosis, biomedical standardization, incarceration, anthropology of medicine and science]
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Microbus crashes and Coca-Cola cash: The value of death in “free-market” El Salvador
ELLEN MOODIE
In this article, I explore valuation of dead bodies in postwar El Salvador. Taking the view that human-rights violations are, in Paul Farmer’s words, “symptoms of deeper pathologies of power,” I start with the seemingly random violence of a fatal bus crash. I then broaden the focus to other categories of suffering undervalued by institutional discourses. The shift in death’s meanings comprises a political project undermining the collective agency that sustained revolutionary efforts. The value of death has been (re)privatized and individualized in a way that has extended anguish. These changes in value index links between violence and the position of states and citizens in the world market.
[human rights, death, war, neoliberalism, mobility, structural violence, El Salvador]
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Aged bodies and kinship matters: The ethical field of kidney transplant
SHARON R. KAUFMAN, ANN J. RUSS, and JANET K. SHIM
The number of kidneys transplanted to people over age 70, both from living and cadaver donors, has increased steadily in the past two decades in the United States. Live kidney donation, on the rise for all age groups, opens up new dimensions of intergenerational relationship and medical responsibility when the transfer of organs is from younger to older people. There is little public knowledge or discussion of this phenomenon, in which the site of ethical judgment and activism about longevity and mortality is one’s regard for the body of another and the substance of the body itself is ground for moral consideration about how kinship is “done.” The clinic, patient, and patient’s family together shape a bond between biological identity and human worth, a demand for an old age marked by somatic pliability and renewability, and a claim of responsibility that merges the “right to live” and “making live.” Live kidney transplantation joins genetic, reproductive, and pharmacological forms of social participation as one more technique linking ethics to intervention and the understanding of the arc of human life to clinical opportunity and consumption. Significant in this example is the medicocultural scripting of transplant choice that becomes a high-stakes obligation in which the long-term impacts on generational relations cannot be foreseen.
[culture of medicine, life extension, intersubjectivity, biopolitics, life itself, kinship and kidney transplant, United States]
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Inter-Mediation and Self-Interest

On the edge of empire: Military brokers in the Sepik “tribal zone”
LAWRENCE BRAGGE, ULRIKE CLAAS, and PAUL ROSCOE
Military brokers have played a decisive role in human affairs, but pragmatic obstacles make this an exceedingly difficult phenomenon to examine. Capitalizing on an unpublished documentary archive of interviews conducted in the early 1970s, we attempt a partial reconstruction of three barely known but consequential episodes of military brokerage in the early encounter between empire and the Middle Sepik people of New Guinea. In these incidents, “ethnic soldiers” emerge as classic brokers, monopolizing and manipulating the flow of information between colonial overlords and local populations to leverage power and advance their own agendas.
[brokers, military brokerage, war, tribal zone, Sepik, Melanesia.]
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Early European–Polynesian contact reenacted: Anutan “handling” of a foreign fishing vessel
RICHARD FEINBERG
This article recounts an incident in which many of the dynamics of early contact between European sailors and Pacific Islanders appear to have played out. The event occurred in 1973 on Anuta, a remote Polynesian enclave in the eastern Solomon Islands. Over a three-day period, islanders acquired highly valued commodities from a Taiwanese fishing boat through a combination of extortion and some very tough negotiations. This incident, I argue, helps to supply a missing piece in the puzzle of early contact.
[Polynesia, history, early contact]
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Building down and dreaming up: Finding faith in a Mexican multilevel marketer
PETER S. CAHN
Scholars and journalists have heralded the spread of direct sellers like Avon and Amway in the developing world as providing a training ground for capitalist entrepreneurs. By examining ethnographic evidence from Omnilife, a Mexican producer of nutritional supplements, I argue that person-to-person marketing is not a rationalist response to neoliberal economic reforms but, rather, a spiritual one. Quasi-religious organizations like Omnilife promise workers a renewed self-image that restores the balance between individual interests and obligations to others that has been disrupted by neoliberal economic reforms. In pursuing this total transformation, workers accept mechanisms of control that mask the company’s overriding profit motive.
[multilevel marketing, Mexico, neoliberalism, emotional labor, quasi-religious organizations]
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